Estimating the effect of diuretics and inhaled corticosteroids for evolving bronchopulmonary dysplasia in preterm infants.

IF 2.7 3区医学 Q2 OBSTETRICS & GYNECOLOGY Paediatric and perinatal epidemiology Pub Date : 2024-08-01 Epub Date: 2024-01-08 DOI:10.1111/ppe.13038

Jonathan L Slaughter, Mark A Klebanoff, Erinn M Hade

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Abstract

Background: Off-label treatment of extremely preterm infants with diuretics and inhaled corticosteroids (ICS) for evolving bronchopulmonary dysplasia (BPD) is common. Their effectiveness in reducing mortality or BPD severity, and optimal treatment timing, are unclear.

Objectives: To determine whether diuretic treatment or ICS administration for infants with early evolving (between 10-27 days postnatal) and progressively evolving (28th-day-36th-week postnatal) BPD are independently associated with reduced mortality and moderate or severe BPD at 36-weeks postmenstrual age (PMA).

Methods: We examined neonates born before 28 weeks' gestation and admitted to neonatal intensive care units on postnatal Day 0 between 2006 and 2016 using data collected during routine care recorded within the Paediatric Health Information System (PHIS). An early evolving BPD cohort consisted of infants treated with oxygen, positive pressure or mechanical ventilation at 10 days postnatal. The progressively evolving BPD cohort consisted of infants treated with these modalities at 28 days. In new users, we evaluated the effect of diuretic and ICS treatment on mortality or BPD severity at 36 weeks PMA, adjusting for time-dependent confounding by respiratory status using marginal structural models.

Results: Early evolving BPD was present in 10,135 patients; progressively evolving BPD in 11,728. New diuretic exposure during early evolving BPD (adjusted risk ratio [aRR] 0.77, 95% confidence interval [CI] 0.65, 0.93) was associated with decreased mortality or moderate/severe BPD risk. New diuretics (aRR 0.86, 95% CI 0.75, 0.99) during progressively evolving BPD between 28-days-36-weeks PMA were less strongly associated with mortality or moderate/severe BPD reduction. There was no strong association for ICS in patients with early evolving (aRR: 1.40; 95% CI: 0.79, 2.51) or progressively evolving BPD (aRR 1.16, 95% CI 0.95, 1.49).

Conclusion: Diuretics, but not ICS, for evolving BPD were associated with mortality and BPD risk reduction.

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估算利尿剂和吸入皮质类固醇对早产儿支气管肺发育不良演变的影响。

背景：使用利尿剂和吸入性皮质类固醇（ICS）对极早产儿进行标签外治疗，以治疗不断发展的支气管肺发育不良（BPD）的情况很常见。它们在降低死亡率或 BPD 严重程度方面的效果以及最佳治疗时机尚不明确：目的：确定对早期演变期（出生后 10-27 天）和进展期（出生后第 28 天-36 周）BPD 患儿进行利尿剂治疗或 ICS 治疗是否与死亡率降低以及月龄后 36 周（PMA）中度或重度 BPD 相关：我们利用儿科健康信息系统（PHIS）中记录的常规护理期间收集的数据，对 2006 年至 2016 年间在妊娠 28 周前出生并在产后第 0 天入住新生儿重症监护室的新生儿进行了研究。早期演变的BPD队列包括出生后10天接受氧气、正压或机械通气治疗的婴儿。逐步发展的 BPD 组群包括出生 28 天后接受过这些方式治疗的婴儿。在新用户中，我们评估了利尿剂和 ICS 治疗对 PMA 36 周时死亡率或 BPD 严重程度的影响，并使用边际结构模型调整了呼吸状态的时间依赖性混杂因素：结果：10135 名患者存在早期演变的 BPD；11728 名患者存在逐渐演变的 BPD。在早期演变的 BPD 期间接触新的利尿剂（调整风险比 [aRR] 0.77，95% 置信区间 [CI] 0.65，0.93）与死亡率或中度/重度 BPD 风险降低有关。在 PMA 28 天-36 周之间 BPD 逐步发展期间，新利尿剂（aRR 0.86，95% CI 0.75，0.99）与死亡率或中度/重度 BPD 降低的相关性较小。ICS与早期发展期（aRR：1.40；95% CI：0.79，2.51）或进行性发展期（aRR：1.16，95% CI：0.95，1.49）BPD患者的关系不大：结论：利尿剂（而非 ICS）治疗不断发展的 BPD 与降低死亡率和 BPD 风险有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Paediatric and perinatal epidemiology 医学-妇产科学

CiteScore

5.40

自引率

7.10%

发文量

审稿时长

1 months

期刊介绍： Paediatric and Perinatal Epidemiology crosses the boundaries between the epidemiologist and the paediatrician, obstetrician or specialist in child health, ensuring that important paediatric and perinatal studies reach those clinicians for whom the results are especially relevant. In addition to original research articles, the Journal also includes commentaries, book reviews and annotations.