消旋肾上腺素治疗细支气管炎对早产儿效更佳

肯塔基州卡温顿——一项图表综述提示，消旋肾上腺素对因细支气管炎入院的早产儿的效果可能较足月婴儿更好。

主要研究者、罗得岛医院儿科的Russell J. McCulloh博士在儿科医院医学会2012年会上指出，很少有研究探讨常用细支气管炎治疗在有早产病史儿童中的有效性，尽管这些儿童更常罹患细支气管炎，并且发生严重预后和住院时间延长的风险更高。

这项图表综述从2个大学附属医院纳入1,222例有或无早产病史的细支气管炎婴儿。其中229例(19%)为早产患儿。

结果显示，基线时，早产患儿的月龄显著大于足月患儿(6.6个月 vs. 5.4个月)，早产儿更少接受日间护理(15.3% vs. 24%)，但更多有喘息史(18% vs. 14%)。早产患儿的平均住院时间较长，为3.8天，足月患儿的平均住院时间为2.5天，但考虑到全身皮质类固醇激素的使用，二者无统计学差异(31% vs. 27.6%；P=0.3)。早产患儿较足月患儿更多需要入住ICU(23% vs. 11%)，并且更可能被诊断为肺炎(9.3% vs. 6%)和接受静脉水化治疗(63% vs. 58.4%)。足月患儿更多有发热记录(45% vs. 36%)，更多被诊断为泌尿系感染(2.4% vs. 0%)。早产婴儿对吸入性消旋肾上腺素的阳性反应率高达54.3%，而足月婴儿仅为28%，二者具有统计学差异(P=0.003)。但早产儿和足月婴儿对沙丁胺醇(喘乐宁、Proventil、VOLMAX、Vospire)的阳性反应率无统计学差异(43.4% vs. 38%；P=0.18)。在逻辑回归分析中，早产与对肾上腺素的反应性增高独立相关(比值比为1.89)。

研究者总结认为，早产的细支气管炎患儿较足月患儿对消旋肾上腺素的反应率更高。

McCulloh医生披露无相关利益冲突。

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By: PATRICE WENDLING, Family Practice News Digital Network

COVINGTON, KY. – Racemic epinephrine may be more effective in premature than in full-term infants who are hospitalized for bronchiolitis, a chart review suggests.

The positive response rate to inhaled racemic epinephrine was significantly higher at 54.3% among premature infants, compared with 28% among full-term infants (P = .003).

In contrast, there was no significant difference in documented positive response rates to albuterol (Proventil, Ventolin, Volmax, Vospire) among premature and full-term infants (43.4% vs. 38%; P = .18), Dr. Russell J. McCulloh reported in a poster at the Pediatric Hospital Medicine 2012 meeting.

He said that few studies have examined the effectiveness of commonly used bronchiolitis therapies in children with a history of premature birth, even though these children are commonly affected by bronchiolitis and are at higher risk of severe outcomes and prolonged stay.

The chart review included 1,222 infants with and without a history of premature birth who were admitted for bronchiolitis to two academic medical centers. Of these, 229 (19%) were premature.

At baseline, preemies were significantly older than full-term infants (6.6 months vs. 5.4 months) and less likely to have day care exposure (15.3% vs. 24%), but more likely to have a history of wheeze (18% vs. 14%).

Premature patients had a significantly longer mean length of stay of 3.8 days compared with 2.5 days among full-term infants, although this did not differ significantly based on systemic steroid use (31% vs. 27.6%; P = .3), noted Dr. McCulloh of the pediatrics division at Rhode Island Hospital, Providence.

Premature infants were significantly more likely than full-term infants to require an ICU stay (23% vs. 11%), and they trended toward more pneumonia diagnosed (9.3% vs. 6%) and IV hydration (63% vs. 58.4%).

Full-term infants had more fever documented (45% vs. 36%) and urinary tract infections diagnosed (2.4% vs. 0%).

In logistic regression analyses, premature birth was independently associated with improved responsiveness to epinephrine (odds ratio, 1.89), Dr. McCulloh reported at the meeting, which was sponsored by the Society of Hospital Medicine, the American Academy of Pediatrics, and the Academic Pediatric Association.

Dr. McCulloh reported having no conflicts of interest.