Akutne i kronične nuspojave kortikosteroida u liječenju novorođenčadi

master's thesis

• Title (english): Acute and chronic side effects of corticosteroids used for treatment of neonatal conditions
• Author: Filip Juroš
• Mentor: Boris Filipović-Grčić (mentor)
• Committee member: Irena Senečić-Čala (predsjednik povjerenstva)
• Committee member: Marija Jelušić (član povjerenstva)
• Committee member: Boris Filipović-Grčić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pediatrics); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Intensive Care

Abstract

Prerano rođena novorođenčad i komplikacije koje se pojavljuju kod njih problem su u cijelome svijetu. Takva djeca su pod velikim rizikom razvijanja kronične plućne bolesti (CLD). S obzirom na upalnu etiologiju CLD-a, kortikosteroidi (KS) predstavljeni su kao logičan izbor liječenja takvog stanja. Oni su se pokazali vrlo učinkovitima u popravljanju plućne funkcije i u ubrzavanju odvajanja djece sa respiratora. Prvi CS korišten za ovu indikaciju bio je deksametazon (DEX) koji se od 1990-tih sve više koristi, do 41% u postnatalno vrijeme, da bi se do danas smanjio na 8%. Razlog tom drastičnom padu uporabe CS-a leži upravo u povezanosti sa akutnim i kroničnim nuspojavama. Uz akutne nuspojave, otkrilo se da CS-i mogu biti povezani s cerebralnom paralizom (CP) u nedonoščadi. S obzirom na to, savjetuje se da se DEX koristi u situacijama kada je novorođenče i nakon 2 do 3 tjedna i dalje mehanički ventilirano i kada postoji izraziti rizik od razvoja CLD-a, i to u što manjoj dozi. Hidrokortizon (HC) je još jedan sintetski CS, koji svojim mogućnostima odgovara kortizolu, istraživan je kao moguća zamjena DEX-u. Dokazi su pokazali da HC ima jednako dobar učinak u novorođenčadi u prevenciji CLD-a i u odvajanju od mehaničke ventilacije kao i DEX. HC nije bio značajno povezan s akutnim nuspojavama kao DEX, osim s povećanom učestalošću spontane intestinalne perforacije u kombinaciji s indometacinom ili ibuprofenom. U studijama koje su pratile djecu tretiranu HC-om kroz 7-8 godina, HC nije bio statistički povezan sa većom učestalošću neuroloških nuspojava ni CP-e. Samo je par studija uočilo neurorazvojne probleme uz liječenje HC-om, no te studije su ili koristile HC rano nakon rođenja u većim dozama ili tijekom dužeg razdoblja (>37 dana). Zaključno, postnatalni CS su korisni u odvajanju od respiratora i u poboljšanju plućne funkcije u nedonoščadi. Međutim, ovi dobri učinci su popraćeni akutnim i kroničnim nuspojavama. Kliničari bi trebali za svakog pojedinog pacijenta odvagnuti koristi i rizike, tako da samo ona novorođenčad koja imaju veliki rizik za razvoj CLD-a budu liječeni KS-ma.

Abstract (english)

Prematurity is a large problem worldwide. Premature infants are at high risk of developing chronic lung disease (CLD). Corticosteroids (CS) have been proven efficient in improving lung function and facilitating weaning of premature infants with CLD from mechanical ventilation. First CS used for this indication was dexamethasone, which was widely used in 1990s, up to 41%, only to fall to 8% to this day. The reason for this large downfall is in connection to severe short- and long-term side effects. CS have been associated with cerebral palsy (CP) in neonates. Keeping that in mind, it is recommended that low-dose DEX is used only when weaning of ventilator is not possible after 2 to 3 weeks and when there is a sever risk of developing CLD. Hydrocortisone (HC) is another synthetic CS, which is closer to cortisol, was investigated as a possible replacement for DEX. The evidence has shown that HC has equal effect in preventing CLD and in weaning of mechanical ventilation. HC was not significantly connected with other acute side-effects, but only with a greater incidence of spontaneous intestinal perforation in combination with indomethacin or ibuprofen. In follow-up studies of HC treated infants through 7-8 years, HC was not statistically connected with greater incidence of neurological side-effects or CP. Only few studies have shown neurodevelopmental impairment with HC, but these studies have either used HC very early in life or over longer period (>37 days). Postnatal CS treatment of preterm infants is helpful in terms of weaning from mechanical ventilation and improving lung function. Clinicians need to outweigh the ratio of risk and benefit for each individual infant they treat, keeping in mind that only infants at high risk of CLD are likely to benefit from this treatment.

• Keywords: deksametazon; hidrokortizon; neurološki razvoj; novorođenče; nuspojave
• Keywords (english): dexamethasone; hydrocortisone; neurodevelopment; newborn; side effects
• Language: croatian
• URN:NBN: urn:nbn:hr:105:503790
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-11-22 12:42:50