Smith L M, Qureshi N, Chao C R
Department of Pediatrics, University of California, Los Angeles School of Medicine, Torrance, USA.
J Matern Fetal Med. 2000 Mar-Apr;9(2):131-5. doi: 10.1002/(SICI)1520-6661(200003/04)9:2<131::AID-MFM9>3.0.CO;2-M.
We compared outcomes between neonates receiving either single course, multiple courses, or no antenatal glucocorticoid exposure.
We retrospectively identified neonates whose mothers received a single course (SIN) of dexamethasone, multiple (2-3) weekly courses (MULT), or no (NO) glucocorticoids. Multiple gestations and infants with chromosomal abnormalities or not receiving a full course of antenatal dexamethasone were excluded from the study. The incidences of the following outcomes were examined: respiratory distress syndrome (RDS), Grades III or IV intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), sepsis, and in-hospital death. Means were compared with analysis of variance and outcome variable frequencies with chi-square test.
A total of 147 infants were included in the analysis. There were no differences in the gestational age or growth parameters among the groups. As anticipated, infants exposed to antenatal glucocorticoids had a significantly lower incidence of morbidities (BPD, NEC, and IVH) than the unexposed infants. There were no differences in the incidence of RDS, IVH, BPD, NEC, ROP, PDA, sepsis, or death between the SIN and MULT groups.
A single course of antenatal glucocorticoid therapy is associated with improved neonatal outcomes in infants less than 30 weeks' gestation. Multiple courses were not shown to confer additional benefits, but further investigation is required to definitively address the need for weekly treatment.
我们比较了接受单疗程、多疗程或未接受产前糖皮质激素暴露的新生儿的结局。
我们回顾性地确定了其母亲接受单疗程地塞米松（SIN）、每周多疗程（2 - 3个疗程）（MULT）或未接受糖皮质激素（NO）的新生儿。多胎妊娠以及患有染色体异常或未接受完整疗程产前地塞米松的婴儿被排除在研究之外。检查了以下结局的发生率：呼吸窘迫综合征（RDS）、III或IV级脑室内出血（IVH）、支气管肺发育不良（BPD）、坏死性小肠结肠炎（NEC）、早产儿视网膜病变（ROP）、败血症和住院死亡。采用方差分析比较均值，采用卡方检验比较结局变量频率。
共有147名婴儿纳入分析。各组之间的胎龄或生长参数无差异。如预期的那样，暴露于产前糖皮质激素的婴儿的发病率（BPD、NEC和IVH）明显低于未暴露的婴儿。SIN组和MULT组之间在RDS、IVH、BPD、NEC、ROP、动脉导管未闭（PDA）、败血症或死亡的发生率方面没有差异。
单疗程产前糖皮质激素治疗与孕周小于30周婴儿的新生儿结局改善相关。多疗程未显示出额外的益处，但需要进一步研究以明确解决每周治疗的必要性。
