ImportanceSystemic postnatal corticosteroids have been shown to reduce rates of bronchopulmonary dysplasia (BPD) in infants born preterm, but both corticosteroids and BPD are associated with cerebral palsy.ObjectiveTo describe how the association between systemic postnatal corticosteroids and survival free of cerebral palsy varies with the risk of BPD in infants born preterm, and if the association differs between dexamethasone and hydrocortisone, or with age at starting treatment.Design, Setting, and ParticipantsThis comparative effectiveness research used weighted meta-regression analysis of eligible randomized clinical trials (RCTs) of systemic postnatal corticosteroids reported from June 1989 through March 2022 that included rates of all of BPD, mortality, and cerebral palsy in neonatal intensive care units in 10 countries. Infants born preterm at risk of BPD were included. Data were analyzed from April and July 2024.InterventionsSystemic dexamethasone or hydrocortisone.Main Outcomes and MeasuresType and timing of corticosteroid, control group rate of BPD, and risk difference in survival free of cerebral palsy between corticosteroid and control arms.ResultsTwenty-six RCTs with data on 3700 randomized infants were eligible; 18 (69%) investigated dexamethasone and 8 (31%) hydrocortisone; 12 (46%) started treatment in the first week after birth. There was evidence for a differential association of the type of corticosteroid with the effect of systemic dexamethasone on survival free of cerebral palsy and the risk of BPD in control groups (interaction coefficient, 0.54; 95% CI, 0.25-0.82; P = .001). For dexamethasone, for every 10–percentage point increase in the risk of BPD, the risk difference for survival free of cerebral palsy increased by 3.74% (95% CI, 1.54 to 5.93; P = .002). Dexamethasone was associated with improved survival free of cerebral palsy at a risk of BPD greater than 70%. Conversely, dexamethasone was associated with harm at a risk of BPD less than 30%. There was some evidence for a negative association with hydrocortisone, with possible benefit with risk of BPD less than 30%. There was no strong evidence for a differential effect of timing among those treated with dexamethasone (interaction coefficient, 0.13; 95% CI, −0.04 to 0.30; P = .14).Conclusions and RelevanceThe findings suggest that dexamethasone (compared with control) was associated with improved rates of survival free of cerebral palsy in infants at high risk of BPD but should be avoided in those at low risk. A role for hydrocortisone is uncertain.

中文翻译：

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全身性产后皮质类固醇、支气管肺发育不良和无脑瘫的生存率


重要性产后全身性皮质类固醇已被证明可以降低早产儿支气管肺发育不良 （BPD） 的发生率，但皮质类固醇和 BPD 都与脑瘫有关。目的描述全身性产后皮质类固醇与无脑瘫生存率之间的关联如何随早产儿 BPD 风险的变化而变化，以及地塞米松和氢化可的松之间的关联是否不同，或与开始治疗的年龄不同。设计、设置和参与者这项比较有效性研究使用了 1989 年 6 月至 2022 年 3 月报告的符合条件的全身性产后皮质类固醇随机临床试验 （RCT） 的加权荟萃回归分析，其中包括 10 个国家新生儿重症监护病房的所有 BPD 发生率、死亡率和脑瘫。纳入有 BPD 风险的早产儿。数据分析了 2024 年 4 月和 7 月。主要结局和测量皮质类固醇的类型和时间、BPD 的对照组发生率以及皮质类固醇和对照组之间无脑瘫生存的风险差异。结果26 项 RCT 涉及 3700 名随机婴儿的数据;18 例 （69%） 调查了地塞米松，8 例 （31%） 调查了氢化可的松;12 例 （46%） 在出生后第一周开始治疗。有证据表明，皮质类固醇类型与全身性地塞米松对对照组无脑瘫生存率和 BPD 风险的影响存在差异关联（交互系数，0.54;95% CI，0.25-0.82;P = .001）。对于地塞米松，BPD 风险每增加 10 个百分点，无脑瘫生存的风险差异增加 3.74%（95% CI，1.54 至 5。93;P = .002）。地塞米松与无脑瘫生存率提高相关，BPD 风险大于 70%。相反，地塞米松与 BPD 风险低于 30% 的伤害相关。有一些证据表明与氢化可的松呈负相关，BPD 风险低于 30% 可能有益。没有强有力的证据表明地塞米松治疗组的时间效应不同（交互系数，0.13;95% CI，-0.04 至 0.30;P = .14）。结论和相关性研究结果表明，地塞米松（与对照组相比）与 BPD 高危婴儿无脑瘫生存率的提高有关，但应避免在低风险婴儿中。氢化可的松的作用尚不确定。