Schaap A H, Wolf H, Bruinse H W, Smolders-De Haas H, Van Ertbruggen I, Treffers P E
Department of Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Obstet Gynecol. 2001 Jun;97(6):954-60. doi: 10.1016/s0029-7844(01)01343-6.
To evaluate the effect of antenatal corticosteroids on mortality, morbidity, and disability or handicap rate in early preterm, growth-restricted infants.
This case-control study in two tertiary care centers included all live-born singleton infants with growth-restriction due to placental insufficiency, who were delivered by cesarean because of cardiotocographic signs of fetal distress before the beginning of labor at a gestational age of 26-32 weeks during the years 1984-1991. Infants who had been treated antenatally with corticosteroids more than 24 hours and less than 7 days before birth were matched by birth weight, sex, and year of birth with infants whose mothers had been admitted more than 24 hours before delivery but were not treated antenatally with steroids. The main outcome measure was survival without disability or handicap at 2 years corrected age. A sample of 60 case-control pairs would give 81% power to demonstrate 50% increase of this outcome [odds ratio (OR) 3.0] by corticosteroid treatment. Behavior and physical growth were evaluated at school age by questionnaire.
The study group and control group consisted of 62 infants each. Survival without disability or handicap at 2 years' corrected age was more frequent in the corticosteroid group [OR 3.2, confidence interval (CI) 1.1, 11.2]. In the long-term follow-up at school age there was a statistically significant negative effect on physical growth (OR 5.1, CI 1.4, 23.8), but no differences in behavior were detected.
Benefits from antenatal corticosteroids for early preterm, growth-restricted infants appear to outweigh possible adverse effects.
评估产前使用糖皮质激素对早期早产、生长受限婴儿死亡率、发病率及残疾或残障率的影响。
本病例对照研究在两家三级医疗中心开展，纳入了1984年至1991年间，因胎盘功能不全导致生长受限的所有单胎活产婴儿，这些婴儿在孕26至32周临产开始前因胎儿窘迫的胎心监护征象而行剖宫产。在出生前24小时以上且少于7天接受过产前糖皮质激素治疗的婴儿，按出生体重、性别和出生年份，与母亲在分娩前24小时以上入院但未接受产前糖皮质激素治疗的婴儿进行匹配。主要结局指标为校正年龄2岁时无残疾或残障存活。60对病例对照样本将有81%的把握度证明糖皮质激素治疗可使该结局增加50%[比值比（OR）3.0]。学龄期通过问卷评估行为和身体生长情况。
研究组和对照组各有62名婴儿。糖皮质激素组校正年龄2岁时无残疾或残障存活更为常见[OR 3.2，置信区间（CI）1.1，11.2]。在学龄期的长期随访中，对身体生长有统计学显著的负面影响（OR 5.1，CI 1.4，23.8），但未检测到行为方面的差异。
产前糖皮质激素对早期早产、生长受限婴儿的益处似乎超过可能的不良影响。
