Historically, postnatal corticosteroids have been used to prevent and treat bronchopulmonary dysplasia (BPD), a significant cause of morbidity and mortality in preterm infants. Administering dexamethasone to prevent BPD in the first 7 days post-birth has been associated with increasing risk for cerebral palsy, while early inhaled corticosteroids appear to be associated with an increased risk of mortality. Neither medication is presently recommended to prevent BPD. New evidence suggests that prophylactic hydrocortisone, when initiated in the first 48 hours post-birth, at a physiological dose, and in the absence of indomethacin, improves survival without BPD, with no adverse neurodevelopmental effects at 2 years. This therapy may be considered by clinicians for infants at highest risk for BPD. Routine dexamethasone therapy for all ventilator-dependent infants is not recommended, but after the first week post-birth, clinicians may consider a short course of low-dose dexamethasone (0.15 mg/kg/day to 0.2 mg/kg/day) for individual infants at high risk for, or with evolving, BPD. There is no evidence that hydrocortisone is an effective or safe alternative to dexamethasone for treating evolving or established BPD. Current evidence does not support inhaled corticosteroids for the treatment of BPD.
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机译:从历史上看,产后皮质类固醇已经被用于预防和治疗支气管肺发育不良(BPD),发病率和死亡率的原因显著早产儿。管理地塞米松预防BPD前7天后出生一直与风险增加了脑瘫,而早期吸入糖皮质激素似乎与死亡的风险增加关联。目前建议既不服药预防BPD。新的证据表明,预防性氢化可的松,在第一个48小时后发起出生,在生理剂量时,并且在没有吲哚美辛,提高生存率无BPD,具有2年无不良神经发育影响。这种疗法可通过临床医生在对BPD风险最高的婴儿被认为。不推荐用于所有依赖呼吸机的婴儿常规地塞米松治疗,但第一周后出生后,临床医生可考虑小剂量地塞米松的个别的短期课程(0.15毫克/千克/天至0.2mg / kg /天)在高危儿的,或与不断发展,BPD。目前没有证据表明,氢化可的松是一种有效或安全的替代地塞米松治疗进化或成立BPD。目前的证据并不支持吸入糖皮质激素对BPD的治疗。
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