Steroid treatment in bronchopulmonary dysplasia

Yıl 2015, , 80 - 83, 16.03.2015

Selahattin Akar , Sevilay Topçuoğlu , Güner Karatekin , Fahri Ovalı

https://doi.org/10.16948/zktb.26917

Öz

Objective: Bronchopulmonary Dysplasia (BPD) is a chronic lung disease of premature newborns treated with positive pressure ventilation and oxygen. In this study we aimed to evaluate the efficiency of steroid usage in BPD patients.

Material and Method: Eighteen preterm newborn born between 01.01.2012 and 21.12.2012 were enrolled to the study. The oxygen need before and after treatment was evaluated. 

Results: The mean gestational age of patients were 26.81±1.87(24-31) weeks, length of hospital stay 77.5±12.92(23-142) days, length of steroid treatment 7.85±3.43 (3-11 ) days, starting with treatment 39.8±17.11 (14-79) days,  mean cumulative  dosage of steroid 0.65±0.27(0.3-1.2) mg/kg, extubation day after  treatment 7.82±8.14 (1-28), leaving CPAP after treatment 16.6±14.4(4-61). At the beginning of the treatment 14 patients were intubated and 4 were in CPAP. After treatment one of the four patients in CPAP stayed in CPAP, one needed oxygen in hood, one in free flow and the other no more oxygen treatment, from 14 intubated patients 5 needed nasal CPAP, one  oxygen in hood, one in free flow and the other 7 stated intubated.

Discussion: Although steroids are used in many centers in different therapy schedules, short term effects are still controversial. Since many factors confine to perform a randomized controlled study on this subject, observational studies are very important to gather more information.

Anahtar Kelimeler

bronchopulmonary dysplasia, steroid, chronic lung disease

Bronkopulmoner displazi tedavisinde sistemik steroid kullanımı

Öz

Amaç: Bronkopulmoner displazi (BPD) oksijen ve pozitif basınçlı ventilasyon ile tedavi edilen prematüre bebeklerde gelişen kronik bir akciğer hastalığıdır. Bu çalışmada, BPD gelişen, sistemik steroid kullanılan olgularda tedavi etkinliğinin değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntem: Çalışmaya 1 Ocak 2012 ile 31 Aralık 2012 tarihleri arasında Yenidoğan Yoğun Bakım Ünitesine yatırılarak izlenen, BPD gelişen ve solunum destek tedavisi gereken 18 prematüre bebek alındı. Steroid kullanım öncesi ve sonrası solunum destek durumları değerlendirildi.

Bulgular: Hastaların gestasyon yaşları ortalama 26,81±1,87 (24-31) hafta, yatış süresi ortalama 77,5±12,92 (23-142) gün, steroid tedavi süresi ortalama 7,85±3,43 (3-11) gün, postanatal steroid başlanma zamanı ortalama 39,8±17,11 (14-79) gün,kümülatif steroid dozu ortalama 0,65±0,27 (0,3-1,2) mg/kg, steroid başlandıktan sonra ekstube olduğu gün ortalama 7,82±8,14 (1-28), steroid başlandıktan sonra nazal CPAP’ın  (Continuous Positive Airway Pressure)  kesildiği  gün ortalama 16,6±14,4 (4-61) idi. Steroid başlandığında 14 hasta entübe,4 hasta  nazal CPAP tedavisi almaktaydı. Steroid sonlandığında nazal CPAP alan 4 hastadan birinin oksijeni kesilmiş, biri hood içi oksijenle izlenmeye geçmiş, biri kövöz içi oksijenle izleme geçmiş, biri nazal CPAP’ta izlenmeye devam edilmişti. Entübe olan 14 hastadan 5’i nazal CPAP’a geçmiş, 1’i küvöz içi oksijenle izleme alınmış,1’i hood içi oksijen ile 7’si entübe olarak izlenmeye devam edilmişti.

Sonuç: Bronkopulmoner displazi tedavisinde steroidler birçok merkezde farklı şekilde kullanılmasına rağmen kısa dönemdeki etkileri tartışmalıdır. Bu konuyla ilgili randomize kontrollü çalışma yapılması birçok nedenden dolayı zor olduğu için ancak bildirilen vaka grupları ile karar vermek gerekecektir.

Anahtar Kelimeler

Bronkopulmoner displazi, steroid, kronik akciğer hastalığı

Kaynakça

• Northway WH Jr, Rosan RC, Porter DY. Pulmonary disease following respirator theraphy of membrane disease. N Engl J Med 1967; 276: 357-68.
• Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am j Respir Crit Care Med 2001; 163: 1723-9.
• Koç E. Yeni Bronkopulmoner Displazi. T Klin J Ped 2004; 2:396-402.
• Kolsuz D.L,Demirel B,Gürsoy T,Karatekin G,Ovalı F.Erken Membran Rüptürünün Preterm Bebeklerde Morbidite ve Mortalite Üzerine Etkisinin Araştırılması.Zeynep Kamil Tıp Bülteni 2013;44:221-226
• Zimmerman JJ, Gabbert D, Shivpuri C, Kayata S, Miller J, Ciesi¬elski W. Meter-dosed, inhaled beclomethasone initiated at birth to prevent bronchopulmonary dysplasia. Pediatr Crit Care Med 2000;1:140-145.
• Hallman M, Peltoniemi O, Saarela T. Early neonatal hydrocortiso¬ne: study rather than treat. Pediatrics 2006;118:2540-2542.
• Lee SK, McMillan DD, Ohlson A, et al. Variations in practice and outcomes in the Canadian NICU Network: 1996-1997. Pediatrics 2000; 106:1070-9.
• Lemons JA, Bauer CR, Oh W, et al. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Reserch Network, January 1995 Through December 1996. Pediatrics 2001: 107 (1): E1.
• Ozkan H, Koksal N, Cetinkaya M, Canitez Y. Risk Factors for Bronchopulmonary Dysplasia. Guncel Pediatri 2008; 6: 66-71.
• Kurt H. Bronkopulmoner Displazi sıklığı,Tıpta uzmanlık tezi.,İstanbul (2012)
• Eichenwald EC, Stark AR. Are postnatal steroids ever justified to treat severe bronchopulmonary dysplasia? Arch Dis Child Fetal Neonatal Ed 2007;92:334-337.
• Cummings JJ, D’Eugionio DB, Gross SJ. A controlled trial of de¬xamethasone in preterm infants at high risk of bronchopulmo¬nary dysplasia. N Engl J Med 1989;320:1505-1510.
• Walsh MC, Yao Q, Horbar JD, Carpenter JH, Lee Sk, Ohlsson A. Changes in the use of postnatal steroids for BPD in 3 large neonatal networks. Pediatrics 2006;118:1328-1335.
• American Academy of Pediatrics, Canadian Paediatric Society. Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants. Pediatrics 2002;109:330-338.
• Canadian Paediatric Society. Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants. J Paediatr Child Health 2002;7:20-28.
• Powell K, Kerkering KW, Barker G, Rozycki HJ. Dexamethasone dosing, mechanical ventilation and the risk of cerebral palsy. J Ma¬ternal Fetal Neonatal Med 2006;19:43-48.
• Bhandari A, Schramm CM, Kimble C, Pappagallo M, Hussain N. Effect of a short course of prednisolone in infants with oxygen dependent bronchopulmonary dysplasia. Pediatrics 2008;121:344-349.
• Smolkin T, Steinberg M, Sujov E, Mezer E, Tamir A, Makhoul IR. Late postnatal systemic steroids predispose to retinopathy of prematurity in very-low-birth-weight infants: a comparative study. Acta Paediatrica 2008;97:322-326.
• Doyle LW, Davis PG, Morley CJ, McPhee A, Carlin JB: DART Study Investigators. Low dose dexamethasone facilitates extubati¬on among chronically ventilator-dependent infants: A multicenter, international, randomized, controlled trial. Pediatrics 2006;117:75-83.
• Ohlsson A, Calvert SA, Hosking M, Shennan AT. Randomized controlled trial of dexamethasone treatment in very-low-birth-weight infants with ventilator-dependent chronic lung disease. Acta Paediatr 1992;81:751–756.
• Avery GB, Fletcher AB, Kaplan M, Brudno DS. Controlled trial of dexamethasone in respirator-dependent infants with broncho¬pulmonary dysplasia. Pediatrics 1985;75:106–111.
• Powell K, Kerkering KW, Barker G, Rozycki HJ. Dexamethasone dosing, mechanical ventilation and the risk of cerebral palsy. J Ma¬ternal Fetal Neonatal Med 2006;19:43-48.
• Walsh MC, Yao Q, Horbar JD, Carpenter JH, Lee Sk, Ohlsson A. Changes in the use of postnatal steroids for BPD in 3 large neonatal networks. Pediatrics 2006;118:1328-1335.
• Eichenwald EC, Stark AR. Are postnatal steroids ever justified to treat severe bronchopulmonary dysplasia? Arch Dis Child Fetal Neonatal Ed 2007;92:334-337.
• Lex W. Doyle, Peter G. Davis, Colin J. Morley, Andy McPhee and John B. Carlin. Low-Dose Dexamethasone Facilitates Extubation Among Chronically Ventilator-Dependent Infants: A Multicenter, International, Randomized, Controlled Trial. Pediatrics 2006;117;75
• Walther FJ, Findlay RD, Durand M. Adrenal suppression and extubation rate after moderately early low-dose dexamethasone therapy in very preterm infants. Early Hum Dev.2003;74(1):37– 45