Halliday Henry L
Royal Maternity Hospital, and Department of Child Health, Queen's University of Belfast, Belfast, Northern Ireland.
Paediatr Respir Rev. 2004;5 Suppl A:S321-7. doi: 10.1016/s1526-0542(04)90057-7.
Corticosteroids can be used prenatally to mature the fetal lungs and postnatally to treat or prevent chronic lung disease (CLD). Randomised controlled trials have been performed to evaluate the benefits and risks of perinatal corticosteroid therapy.
Systematic reviews of randomised controlled trials of prenatal and postnatal corticosteroids in the Cochrane Library were examined to determine the cost-benefit ratios of treatment. Outcomes are given as numbers needed to treat (NNT) or numbers needed to harm (NNH) with 95% confidence intervals (CI).
Prenatal corticosteroids reduce the risk of RDS (NNT 11; 95% CI 9-16), surfactant use (NNT 9; 95% CI 5-62), intraventricular haemorrhage (NNT 9; 95% CI 6-19) and neonatal mortality (NNT 23; 95% CI 16-42). There are no short-term or long-term adverse effects of a single course of prenatal betamethasone. However, repeated courses of prenatal steroids could be harmful and should be avoided outside of a randomised controlled trial. Postnatal corticosteroids can be used to prevent CLD (early use) or to treat it (late use). Beneficial effects include earlier extubation (typical NNT 5; 95% CI 4-10), reduced CLD (typical NNT 10; 95% CI 8-17) and avoidance of late steroids (NNT 7; 95% CI 6-10). However, there are significant adverse short-term effects such as hyperglycaemia (typical NNH 8; 95% CI 6-10), hypertension (typical NNH 10; 95% CI 8-14). Hy- pertrophic cardiomyopathy (typical NNH 5; 95% CI 4-11), gastrointestinal bleeding (typical NNH 17; 95% CI 11-33) and growth failure (NNH 2; 95% CI 1-2). More important are long-term adverse effects of cerebral palsy (typical NNH 8; 95% CI 6-17), developmental delay (typical NNH 7; 95% CI 4-33) and abnormal neurological examination (typical NNH 4; 95% CI 2-14). These adverse effects are more pronounced with early (<96 h) treatment but probably also occur when steroids are given later in the postnatal period.
A single course of prenatal betamethasone has clear benefits for the fetus who is likely to be born preterm but repeated courses may be harmful. Postnatal steroids should be avoided if at all possible. They might be indicated in very low doses for ventilator-dependent infants who might otherwise die without them.
皮质类固醇可在产前用于促进胎儿肺成熟，产后用于治疗或预防慢性肺病（CLD）。已开展随机对照试验来评估围产期皮质类固醇治疗的益处和风险。
查阅Cochrane图书馆中关于产前和产后皮质类固醇随机对照试验的系统评价，以确定治疗的成本效益比。结果以治疗所需人数（NNT）或伤害所需人数（NNH）及95%置信区间（CI）表示。
产前使用皮质类固醇可降低呼吸窘迫综合征（RDS）风险（NNT 11；95%CI 9 - 16）、表面活性剂使用（NNT 9；95%CI 5 - 62）、脑室内出血（NNT 9；95%CI 6 - 19）和新生儿死亡率（NNT 23；95%CI 16 - 42）。单次产前倍他米松疗程无短期或长期不良影响。然而，重复产前使用类固醇可能有害，应避免在随机对照试验之外使用。产后皮质类固醇可用于预防CLD（早期使用）或治疗CLD（晚期使用）。有益效果包括更早拔管（典型NNT 5；95%CI 4 - 10）、降低CLD发生率（典型NNT 10；95%CI 8 - 17）以及避免晚期使用类固醇（NNT 7；95%CI 6 - 10）。然而，存在显著的短期不良影响，如高血糖（典型NNH 8；95%CI 6 - 10）、高血压（典型NNH 10；95%CI 8 - 14）、肥厚型心肌病（典型NNH 5；95%CI 4 - 11）、胃肠道出血（典型NNH 17；95%CI 11 - 33）和生长发育迟缓（NNH 2；95%CI 1 - 2）。更重要的是，长期不良影响包括脑瘫（典型NNH 8；95%CI 6 - 17）、发育延迟（典型NNH 7；95%CI 4 - 33）和神经系统检查异常（典型NNH 4；95%CI 2 - 14）。这些不良影响在早期（<96小时）治疗时更为明显，但在产后晚期使用类固醇时可能也会出现。
单次产前倍他米松疗程对可能早产的胎儿有明显益处，但重复疗程可能有害。应尽可能避免产后使用类固醇。对于依赖呼吸机的婴儿，若不使用可能死亡，可考虑极低剂量使用。
