Background

Preterm neonates often require glucocorticoids to manage refractory hypotension, prevent, and treat bronchopulmonary dysplasia. We have investigated the effect of cumulative dose and duration of glucocorticoids on blood pressure and renal function in VLBW infants.

Methods

In this retrospective cohort study, medical records of infants (GA ≤ 35 weeks) born January 2015 to December 2019 were reviewed to extract demographic and clinical characteristics, dose and duration of steroids, blood pressure (BP), and creatinine at the time of discharge from the neonatal intensive care unit.

Results

Two hundred and eighty-three neonates with average GA (28 ± 3 weeks) and birthweight (1060±381 g). Twenty-eight percent (33/116) of infants who received postnatal steroids developed hypertension versus 16% (27/167) of controls (OR = 2.0, p = 0.011). There was a correlation between the cumulative dosage of postnatal steroids and systolic BP (R² = 0.06, p < 0.001). With increasing steroid dose and total steroid days, there was a significant increase in creatinine clearance at the time of discharge (R² = 0.13, p < 0.001; R² = 0.13, p < 0.001, respectively).

Conclusions

Cumulative dose of postnatal steroids and duration of use is associated with increased systolic BP in premature infants. Postnatal steroids should be used prudently to prevent long-term cardiovascular and renal morbidity.

Impact

• Preterm neonates are exposed to a high dose of glucocorticoids during their neonatal intensive care stay.

• The dose and duration of use of postnatal glucocorticoids was associated with significant increase in blood pressure at the time of discharge in preterm neonates.

• Postnatal glucocorticoid use is associated with improved creatinine clearance likely due to a state of hyperfiltration and may lead to chronic kidney disease later in life.

• Postnatal glucocorticoids should be used prudently in this highly vulnerable population

中文翻译：

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产后使用糖皮质激素会影响 VLBW 新生儿的肾功能

背景

早产新生儿通常需要糖皮质激素来控制顽固性低血压、预防和治疗支气管肺发育不良。我们研究了糖皮质激素的累积剂量和持续时间对极低出生体重儿的血压和肾功能的影响。

方法

在这项回顾性队列研究中，回顾了 2015 年 1 月至 2019 年 12 月出生的婴儿（GA ≤ 35 周）的医疗记录，以提取出院时的人口统计学和临床​​特征、类固醇的剂量和持续时间、血压 (BP) 和肌酐来自新生儿重症监护病房。

结果

283 名新生儿，平均 GA（28 ± 3 周）和出生体重（1060±381 g）。接受产后类固醇治疗的婴儿中有 28% (33/116) 出现高血压，而对照组为 16% (27/167)（OR = 2.0，p  = 0.011）。产后类固醇的累积剂量与收缩压之间存在相关性 ( R ²  = 0.06, p  < 0.001)。随着类固醇剂量和总类固醇天数的增加，出院时肌酐清除率显着增加（分别为R ²  = 0.13，p  < 0.001；R ²  = 0.13，p  < 0.001）。

结论

产后类固醇的累积剂量和使用持续时间与早产儿收缩压升高有关。应谨慎使用产后类固醇，以预防长期的心血管和肾脏疾病。

影响

• 早产新生儿在新生儿重症监护期间会接触到高剂量的糖皮质激素。

• 产后糖皮质激素使用的剂量和持续时间与早产新生儿出院时血压显着升高有关。

• 产后糖皮质激素的使用与肌酐清除率的改善相关，这可能是由于高滤过状态所致，并可能在以后的生活中导致慢性肾病。

• 在这个高度脆弱的人群中应谨慎使用产后糖皮质激素