Wijnberger Lia D E, Mostert Johanneke M, van Dam Karen I, Mol Ben W J, Brouwers Hens, Visser Gerard H A
Department of Obstetrics, University Medical Center Utrecht, KJ02.507.0, Wilhelmina Children's Hospital, P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
Early Hum Dev. 2002 Apr;67(1-2):29-36. doi: 10.1016/s0378-3782(01)00248-1.
In the case of threatened preterm delivery, repeat administration of antenatal corticosteroids is a common practice in women who have not delivered 7-14 days after the first course of corticosteroids. However, the benefits of this policy as compared to single-course administration have not been proven.
Our purpose was to compare neonatal death and morbidity after repeat antenatal courses of corticosteroids with neonatal death and morbidity after a single course.
We performed a cohort study with matched controls. Neonates treated with repeat antenatal courses of corticosteroids were matched with neonates treated with a single course. Matching criteria were sex, single or multiple gestation, route of delivery, gestational age at delivery and year of birth. Intrauterine growth-restricted infants were matched separately. We excluded neonates with congenital malformation and neonates with an unknown number of antenatal corticosteriod courses. Outcome measures were the incidences of neonatal death, respiratory distress syndrome, intraventricular haemorrhage and necrotizing enterocolitis.
From the neonates treated with two or three courses of antenatal corticosteroids, 56 appropriate grown neonates and 24 intrauterine growth-restricted neonates could be matched. The incidences of neonatal death, respiratory distress syndrome, intraventricular haemorrhage and necrotizing enterocolitis did not show statistically significant differences after single and repeat courses of corticosteroids. Appropriate grown and intrauterine growth-restricted neonates showed the same results.
From our study, it can be concluded that in preterm neonates, repetition of antenatal corticosteroids seems not to improve neonatal outcome.
对于有早产风险的孕妇，在首次使用产前糖皮质激素7 - 14天后仍未分娩的情况下，重复使用糖皮质激素是一种常见做法。然而，与单次使用相比，这种策略的益处尚未得到证实。
我们的目的是比较重复使用产前糖皮质激素疗程后的新生儿死亡和发病率与单次疗程后的新生儿死亡和发病率。
我们进行了一项匹配对照的队列研究。接受重复产前糖皮质激素疗程治疗的新生儿与接受单次疗程治疗的新生儿进行匹配。匹配标准为性别、单胎或多胎妊娠、分娩途径、分娩时的孕周和出生年份。宫内生长受限的婴儿单独进行匹配。我们排除了患有先天性畸形的新生儿和产前糖皮质激素疗程数量不明的新生儿。观察指标为新生儿死亡、呼吸窘迫综合征、脑室内出血和坏死性小肠结肠炎的发生率。
从接受两到三个疗程产前糖皮质激素治疗的新生儿中，可匹配56例适于胎龄新生儿和24例宫内生长受限新生儿。单次和重复使用糖皮质激素疗程后，新生儿死亡、呼吸窘迫综合征、脑室内出血和坏死性小肠结肠炎的发生率没有统计学上的显著差异。适于胎龄和宫内生长受限的新生儿显示出相同的结果。
从我们的研究可以得出结论，在早产新生儿中，重复使用产前糖皮质激素似乎并不能改善新生儿结局。
