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JAMA:产前用类固醇可降低非常早产儿死亡风险

  1. 产前
  2. 婴儿死亡
  3. 早产儿
  4. 神经发育损害
  5. 类固醇

来源:EurekAlert! 2012-11-18 10:38

12月7日《美国医学会杂志》刊登了阿拉巴马大学伯明翰分校的Waldemar A. Carlo, M.D.及其同事的研究论文"Association of Antenatal Corticosteroids With Mortality and Neurodevelopmental Outcomes Among Infants B

12月7日《美国医学会杂志》刊登了阿拉巴马大学伯明翰分校的Waldemar A. Carlo, M.D.及其同事的研究论文"Association of Antenatal Corticosteroids With Mortality and Neurodevelopmental Outcomes Among Infants Born at 22 to 25 Weeks' Gestation",这项研究对在23至25 孕周出生的婴儿的母亲给予产前(孩子出生前)皮质类固醇治疗与婴儿死亡率下降或婴儿在18至22个月大的时候的神经发育损伤的减少有关。

Waldemar A. Carlo, M.D.及其同事开展的研究,旨在确认非常早产婴儿在产前接触皮质类固醇是否与其包括死亡或在18至22个月时的孩童期神经发育损害等后果的改善有关。 这一研究包括了从1993年1月至2009年12月间在美国23个学术性围产儿中心的婴儿数据,这些婴儿的出生体重在401克(14.1盎司)至1000 克(35.5盎司)之间(n = 10,541),他们是在22至25孕周的时候出生的。 这些婴儿中有7808人(74.1%)的母亲接受过产前皮质类固醇的治疗。在那些1993年至2008年期间出生的活到18至22个月大的5691个婴儿中,有4924人(86.5%)接受了神经发育的评估。

研究人员发现,那些在产前接触过皮质类固醇的婴儿的死亡或神经发育损害的情况较不常见:在23孕周时出生(分别为83.4% 和 90.5%, 后者没有接触过皮质类固醇);在24孕周时出生(分别为68.4 % 和 80.3 %);在25孕周使出生(分别为52.7 % 为接触过产前皮质类固醇 和 67.9%为没有接触过皮质类固醇);但这种情况没有出现在那些在22孕周出生的婴儿(分别为90.2 % 和93.1%)。

文章的作者写道:“如果母亲接受了产前皮质类固醇的话,在23、24及25 孕周时出生的婴儿所出现的下列事件会显著减少:在18至22个月大时死亡;住院时死亡;死亡、脑室内出血、或脑室周围白质软化[脑损伤的一种];及死亡或坏死性小肠结肠炎[这是一种肠道有部分组织遭毁坏的情况]。对那些在22孕周时出生的婴儿来说,唯一显著较少发生的结果为死亡或坏死性小肠结肠炎(接触过产前皮质类固醇者为73.5% 和没有接触过产前皮质类固醇者为84.5%)。”

然而,文章的作者提醒:“尽管在整个群组中,那些接受了产前类固醇者的完整存活率增加了一倍,但这一数字仍然相对较低(36%)”。

研究人员得出结论:“尽管产前给予皮质类固醇可能改善后果,但它不会在接近存活能力极限的孕周时增加存活率,而且它与较晚孕周时的存活率相比仍然低了许多。应该开展有对照的试验以精准地确定如此早期给予产前皮质类固醇的裨益,但开展这样的试验是困难的。如果该婴儿会得到加护治疗的话,可考虑在23孕周或之后开始给予产前类固醇,因为这种疗法与死亡率和发病率的降低有关。”(生物谷bioon.com)

Association of Antenatal Corticosteroids With Mortality and Neurodevelopmental Outcomes Among Infants Born at 22 to 25 Weeks' Gestation

Waldemar A. Carlo, MD; Scott A. McDonald, BS; Avroy A. Fanaroff, MD; Betty R. Vohr, MD; Barbara J. Stoll, MD; Richard A. Ehrenkranz, MD;et al.

Context Current guidelines, initially published in 1995, recommend antenatal corticosteroids for mothers with preterm labor from 24 to 34 weeks' gestational age, but not before 24 weeks due to lack of data. However, many infants born before 24 weeks' gestation are provided intensive care.

Objective To determine if use of antenatal corticosteroids is associated with improvement in major outcomes for infants born at 22 and 23 weeks' gestation.

Design, Setting, and Participants Cohort study of data collected prospectively on inborn infants with a birth weight between 401 g and 1000 g (N?=?10?541) born at 22 to 25 weeks' gestation between January 1, 1993, and December 31, 2009, at 23 academic perinatal centers in the United States. Certified examiners unaware of exposure to antenatal corticosteroids performed follow-up examinations on 4924 (86.5%) of the infants born between 1993 and 2008 who survived to 18 to 22 months. Logistic regression models generated adjusted odds ratios (AORs), controlling for maternal and neonatal variables.

Main Outcome Measures Mortality and neurodevelopmental impairment at 18 to 22 months' corrected age.

Results Death or neurodevelopmental impairment at 18 to 22 months was significantly lower for infants who had been exposed to antenatal corticosteroids and were born at 23 weeks' gestation (83.4% with exposure to antenatal corticosteroids vs 90.5% without exposure; AOR, 0.58 [95% CI, 0.42-0.80]), at 24 weeks' gestation (68.4% with exposure to antenatal corticosteroids vs 80.3% without exposure; AOR, 0.62 [95% CI, 0.49-0.78]), and at 25 weeks' gestation (52.7% with exposure to antenatal corticosteroids vs 67.9% without exposure; AOR, 0.61 [95% CI, 0.50-0.74]) but not in those infants born at 22 weeks' gestation (90.2% with exposure to antenatal corticosteroids vs 93.1% without exposure; AOR, 0.80 [95% CI, 0.29-2.21]). If the mothers had received antenatal corticosteroids, the following events occurred significantly less in infants born at 23, 24, and 25 weeks' gestation: death by 18 to 22 months; hospital death; death, intraventricular hemorrhage, or periventricular leukomalacia; and death or necrotizing enterocolitis. For infants born at 22 weeks' gestation, the only outcome that occurred significantly less was death or necrotizing enterocolitis (73.5% with exposure to antenatal corticosteroids vs 84.5% without exposure; AOR, 0.54 [95% CI, 0.30-0.97]).

Conclusion Among infants born at 23 to 25 weeks' gestation, antenatal exposure to corticosteroids compared with nonexposure was associated with a lower rate of death or neurodevelopmental impairment at 18 to 22 months.

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