地塞米松DART方案在早产儿支气管肺发育 不良中的应用与发展
Application and Development of Dexamethasone DART Protocol in Bronchopulmonary Dysplasia of Preterm Infants
DOI: 10.12677/acm.2026.1641312, PDF,   
作者: 王 雨, 史 源*：重庆医科大学附属儿童医院新生儿科，儿童少年健康与疾病国家临床医学研究中心，儿童发育疾病研究教育部重点实验室，重庆市卫生健康委儿童重要器官发育与疾病重点实验室，重庆
关键词: 支气管肺发育不良；地塞米松；DART方案；早产儿；Bronchopulmonary Dysplasia； Dexamethasone； DART Protocol； Preterm Infants
摘要: 支气管肺发育不良(Bronchopulmonary Dysplasia, BPD)是极早产儿的常见慢性肺部疾病，其主要病理特征包括肺泡简化、持续性气道炎症及微血管发育阻滞。BPD的有效防治对于改善早产儿长期预后具有重要意义。目前临床中主要采用糖皮质激素等药物辅助患儿撤离呼吸机，但激素应用的短期不良反应及其远期神经系统安全性仍是临床关注的焦点。近年来，地塞米松DART方案凭借其延迟启用、低剂量和短疗程的特点，较好平衡了呼吸获益与神经安全性，在临床广泛应用。本文将对地塞米松DART方案在BPD治疗中的循证证据、安全性评价及未来精准化趋势进行综述，以期为临床实践提供参考。
Abstract: Bronchopulmonary Dysplasia (BPD) is a common chronic lung disease in very preterm infants, primarily characterized by alveolar simplification, persistent airway inflammation, and impaired microvascular development. The effective prevention and management of BPD are crucial for improving the long-term prognosis of preterm infants. Currently, medications such as glucocorticoids are widely used in clinical practice to facilitate weaning from mechanical ventilation. However, the short-term adverse effects and long-term neurological safety of corticosteroid use remain a focal point of clinical concern. In recent years, the dexamethasone DART (Dexamethasone: A Randomized Trial) protocol, characterized by delayed initiation, low dosage, and a short treatment course, has achieved a favorable balance between respiratory benefits and neurological safety, leading to its widespread clinical application. This article reviews the evidence-based research, safety evaluation, and future precision trends of the Dexamethasone DART protocol in the treatment of BPD, aiming to provide a reference for clinical practice.
文章引用：王雨, 史源. 地塞米松DART方案在早产儿支气管肺发育 不良中的应用与发展[J]. 临床医学进展, 2026, 16(4): 822-831. https://doi.org/10.12677/acm.2026.1641312

参考文献

[1] Thébaud, B., Goss, K.N., Laughon, M., Whitsett, J.A., Abman, S.H., Steinhorn, R.H., et al. (2019) Bronchopulmonary Dysplasia. Nature Reviews Disease Primers, 5, Article No. 78. [Google Scholar] [CrossRef] [PubMed]
[2] Gilfillan, M., Bhandari, A. and Bhandari, V. (2021) Diagnosis and Management of Bronchopulmonary Dysplasia. BMJ, 375, n1974. [Google Scholar] [CrossRef] [PubMed]
[3] Cheong, J.L.Y. and Doyle, L.W. (2018) An Update on Pulmonary and Neurodevelopmental Outcomes of Bronchopulmonary Dysplasia. Seminars in Perinatology, 42, 478-484. [Google Scholar] [CrossRef] [PubMed]
[4] Doyle, L.W., Davis, P.G., Morley, C.J., McPhee, A. and Carlin, J.B. (2006) Low-Dose Dexamethasone Facilitates Extubation among Chronically Ventilator-Dependent Infants: A Multicenter, International, Randomized, Controlled Trial. Pediatrics, 117, 75-83. [Google Scholar] [CrossRef] [PubMed]
[5] Doyle, L.W., Cheong, J.L., Hay, S., Manley, B.J., Halliday, H.L. and Soll, R. (2021) Early (< 7 Days) Systemic Postnatal Corticosteroids for Prevention of Bronchopulmonary Dysplasia in Preterm Infants. Cochrane Database of Systematic Reviews, 2021, CD001146. [Google Scholar] [CrossRef] [PubMed]
[6] Yeh, T.F., Lin, Y.J., Lin, H.C., Huang, C.C., Hsieh, W.S., Lin, C.H., et al. (2004) Outcomes at School Age after Postnatal Dexamethasone Therapy for Lung Disease of Prematurity. New England Journal of Medicine, 350, 1304-1313. [Google Scholar] [CrossRef] [PubMed]
[7] Committee on Fetus and Newborn (2002) Postnatal Corticosteroids to Treat or Prevent Chronic Lung Disease in Preterm Infants. Pediatrics, 109, 330-338. [Google Scholar] [CrossRef] [PubMed]
[8] Abiramalatha, T., Ramaswamy, V.V., Bandyopadhyay, T., Somanath, S.H., Shaik, N.B., Pullattayil, A.K., et al. (2022) Interventions to Prevent Bronchopulmonary Dysplasia in Preterm Neonates: An Umbrella Review of Systematic Reviews and Meta-Analyses. JAMA Pediatrics, 176, 502-516. [Google Scholar] [CrossRef] [PubMed]
[9] Doyle, L.W., Cheong, J.L., Hay, S., Manley, B.J. and Halliday, H.L. (2021) Late (≥ 7 Days) Systemic Postnatal Corticosteroids for Prevention of Bronchopulmonary Dysplasia in Preterm Infants. Cochrane Database of Systematic Reviews, 2021, CD001145. [Google Scholar] [CrossRef] [PubMed]
[10] Baud, O., Maury, L., Lebail, F., Ramful, D., El Moussawi, F., Nicaise, C., et al. (2016) Effect of Early Low-Dose Hydrocortisone on Survival without Bronchopulmonary Dysplasia in Extremely Preterm Infants (PREMILOC): A Double-Blind, Placebo-Controlled, Multicentre, Randomised Trial. The Lancet, 387, 1827-1836. [Google Scholar] [CrossRef] [PubMed]
[11] Baud, O., Trousson, C., Biran, V., Leroy, E., Mohamed, D. and Alberti, C. (2017) Association between Early Low-Dose Hydrocortisone Therapy in Extremely Preterm Neonates and Neurodevelopmental Outcomes at 2 Years of Age. JAMA, 317, 1329-1337. [Google Scholar] [CrossRef] [PubMed]
[12] Watterberg, K.L., Walsh, M.C., Li, L., Chawla, S., D’Angio, C.T., Goldberg, R.N., et al. (2022) Hydrocortisone to Improve Survival without Bronchopulmonary Dysplasia. New England Journal of Medicine, 386, 1121-1131. [Google Scholar] [CrossRef] [PubMed]
[13] Onland, W., Cools, F., Kroon, A., Rademaker, K., Merkus, M.P., Dijk, P.H., et al. (2019) Effect of Hydrocortisone Therapy Initiated 7 to 14 Days after Birth on Mortality or Bronchopulmonary Dysplasia among Very Preterm Infants Receiving Mechanical Ventilation: A Randomized Clinical Trial. JAMA, 321, 354-363. [Google Scholar] [CrossRef] [PubMed]
[14] Bassler, D., Plavka, R., Shinwell, E.S., Hallman, M., Jarreau, P., Carnielli, V., et al. (2015) Early Inhaled Budesonide for the Prevention of Bronchopulmonary Dysplasia. New England Journal of Medicine, 373, 1497-1506. [Google Scholar] [CrossRef] [PubMed]
[15] Bassler, D., Shinwell, E.S., Hallman, M., Jarreau, P., Plavka, R., Carnielli, V., et al. (2018) Long-Term Effects of Inhaled Budesonide for Bronchopulmonary Dysplasia. New England Journal of Medicine, 378, 148-157. [Google Scholar] [CrossRef] [PubMed]
[16] Yeh, T.F., Chen, C.M., Wu, S.Y., Husan, Z., Li, T.C., Hsieh, W.S., et al. (2016) Intratracheal Administration of Budesonide/Surfactant to Prevent Bronchopulmonary Dysplasia. American Journal of Respiratory and Critical Care Medicine, 193, 86-95. [Google Scholar] [CrossRef] [PubMed]
[17] Ambalavanan, N., Carlo, W.A., Nowak, K.J., Wiener, L.E., Cosby, S.S., Bhatt, A.J., et al. (2025) Early Intratracheal Budesonide to Reduce Bronchopulmonary Dysplasia in Extremely Preterm Infants: The Budesonide in Babies (BiB) Randomized Clinical Trial. JAMA, 334, 1452-1462. [Google Scholar] [CrossRef] 
[18] Manley, B.J., Kamlin, C.O.F., Donath, S.M., Francis, K.L., Cheong, J.L.Y., Dargaville, P.A., et al. (2024) Intratracheal Budesonide Mixed with Surfactant for Extremely Preterm Infants: The PLUSS Randomized Clinical Trial. JAMA, 332, 1889-1899. [Google Scholar] [CrossRef] [PubMed]
[19] Phattraprayoon, N., Koonrungsesomboon, N. and Na Takuathung, M. (2025) Efficacy of Pulmonary Surfactant with Budesonide in Infants Born at or Less than 28 Weeks’ Gestation: A Systematic Review and Meta-Analysis. Scientific Reports, 15, Article No. 45116. [Google Scholar] [CrossRef] 
[20] Phattraprayoon, N., Tan, B. and Na Takuathung, M. (2025) Efficacy of Pulmonary Surfactant with Budesonide in Premature Infants: A Systematic Review and Meta-Analysis. PLOS ONE, 20, e0312561. [Google Scholar] [CrossRef] [PubMed]
[21] Ekraminasab, S., Noorishadkam, M., Neamatzadeh, H., Lookzadeh, M.H., Mirjalili, S.R., Mazaheri, M., et al. (2025) Meta-Analysis of Budesonide and Surfactant Combination for the Prevention of Bronchopulmonary Dysplasia in Preterm Neonates Based on Gestational Age. Frontiers in Pediatrics, 13, Article ID: 1518957. [Google Scholar] [CrossRef] [PubMed]
[22] Lemyre, B., Dunn, M. and Thebaud, B. (2020) Postnatal Corticosteroids to Prevent or Treat Bronchopulmonary Dysplasia in Preterm Infants. Paediatrics & Child Health, 25, 322-326. [Google Scholar] [CrossRef] [PubMed]
[23] Sweet, D.G., Carnielli, V.P., Greisen, G., Hallman, M., Klebermass-Schrehof, K., Ozek, E., et al. (2023) European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology, 120, 3-23. [Google Scholar] [CrossRef] [PubMed]
[24] Cummings, J.J. and Pramanik, A.K. (2022) Postnatal Corticosteroids to Prevent or Treat Chronic Lung Disease Following Preterm Birth. Pediatrics, 149, e2022057530. [Google Scholar] [CrossRef] [PubMed]
[25] 张蓉, 林新祝, 常艳美, 等. 早产儿支气管肺发育不良营养管理专家共识[J]. 中国当代儿科杂志, 2020, 22(8): 805-814.
[26] Ambalavanan, N., Deutsch, G., Pryhuber, G., Travers, C.P. and Willis, K.A. (2026) The Evolving Pathophysiology of Bronchopulmonary Dysplasia. Physiological Reviews, 106, 197-237. [Google Scholar] [CrossRef] 
[27] Ballard, P.L., Ertsey, R., Gonzales, L.W. and Gonzales, J. (1996) Transcriptional Regulation of Human Pulmonary Surfactant Proteins SP-B and SP-C by Glucocorticoids. American Journal of Respiratory Cell and Molecular Biology, 14, 599-607. [Google Scholar] [CrossRef] [PubMed]
[28] Matalon, S., Bartoszewski, R. and Collawn, J.F. (2015) Role of Epithelial Sodium Channels in the Regulation of Lung Fluid Homeostasis. American Journal of Physiology-Lung Cellular and Molecular Physiology, 309, L1229-L1238. [Google Scholar] [CrossRef] [PubMed]
[29] Doyle, L.W., Davis, P.G., Morley, C.J., McPhee, A. and Carlin, J.B. (2007) Outcome at 2 Years of Age of Infants from the DART Study: A Multicenter, International, Randomized, Controlled Trial of Low-Dose Dexamethasonef. Pediatrics, 119, 716-721. [Google Scholar] [CrossRef] [PubMed]
[30] Chandwani, R., Kline, J., Altaye, M. and Parikh, N. (2026) Postnatal Dexamethasone Treatment for Preterm Infants at High Risk for Bronchopulmonary Dysplasia Is Associated with Improved Regional Brain Volumes: A Prospective Cohort Study. Archives of Disease in Childhood-Fetal and Neonatal Edition, 111, F74-F81. [Google Scholar] [CrossRef] [PubMed]
[31] Douglas, E., Hodgson, K.A., Olsen, J.E., Manley, B.J., Roberts, C.T., Josev, E., et al. (2023) Postnatal Corticosteroids and Developmental Outcomes in Extremely Preterm or Extremely Low Birth Weight Infants: The Victorian Infant Collaborative Study 2016-17 Cohort. Acta Paediatrica, 112, 1226-1232. [Google Scholar] [CrossRef] [PubMed]
[32] Rocha, G., Calejo, R., Arnet, V., de Lima, F.F., Cassiano, G., Diogo, I., et al. (2024) The Use of Two or More Courses of Low-Dose Systemic Dexamethasone to Extubate Ventilator-Dependent Preterm Neonates May Be Associated with a Higher Prevalence of Cerebral Palsy at Two Years of Corrected Age. Early Human Development, 194, Article ID: 106050. [Google Scholar] [CrossRef] [PubMed]
[33] Al-Taweel, H.M., Abdelhady, I.S.I., Irfan, N., Khzzam, F.A., Kamal, A., Thazhe, S.B.K., et al. (2023) Comparing Low-Dose (DART) and Enhanced Low-Dose Dexamethasone Regimens in Preterm Infants with Bronchopulmonary Dysplasia. Frontiers in Pediatrics, 11, Article ID: 1261316. [Google Scholar] [CrossRef] [PubMed]
[34] Gunes, S., Sahin, S., Bozkurt, O., Cezayir, B., Bozgul, A., Gonulal, D., et al. (2025) Enhanced vs. Standard Low Dose Dexamethasone Treatment on Respiratory Outcomes of Preterm Infants with Bronchopulmonary Dysplasia. Frontiers in Pediatrics, 13, Article ID: 1603308. [Google Scholar] [CrossRef] [PubMed]
[35] Zhu, H., Tian, Y., Cheng, H., Zheng, Y., Wang, W., Bao, T., et al. (2021) A Clinical Study on Plasma Biomarkers for Deciding the Use of Adjuvant Corticosteroid Therapy in Bronchopulmonary Dysplasia of Premature Infants. International Journal of Medical Sciences, 18, 2581-2588. [Google Scholar] [CrossRef] [PubMed]
[36] Rigotti, C., Zannin, E., Chiaraluce, S. and Ventura, M.L. (2024) Lung Function Response to Postnatal Corticosteroids for the Prevention and Treatment of Bronchopulmonary Dysplasia. Pediatric Research, 97, 1605-1611. [Google Scholar] [CrossRef] [PubMed]
[37] Kwok, T.C., Manley, B.J., Roehr, C.C. and Sett, A. (2024) Can Pathophysiological Lung Function Markers Guide the Use of Postnatal Corticosteroids for Bronchopulmonary Dysplasia? Pediatric Research, 97, 1420-1421. [Google Scholar] [CrossRef] [PubMed]
[38] Sharma, M., Akangire, G., Hillman, N.H., Manimtim, W.M., Attard, M.I. and Sampath, V. (2025) Defining Endotypes of Bronchopulmonary Dysplasia in Preterm Infants to Improve Precision-Based Therapies. JCI Insight, 10, e193975. [Google Scholar] [CrossRef] 

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