Liu Jing, Wang Qi, Zhao Jin-hui, Chen Yan-hua, Qin Gui-lian
Beijing Obstetrics and Gynecology Hospital Affiliated to Capital University of Medical Science, Beijing, China.
J Trop Pediatr. 2006 Oct;52(5):355-9. doi: 10.1093/tropej/fml028. Epub 2006 Jun 4.
We prospectively evaluated whether combined antenatal corticosteroid and vitamin K administration have any benefit, over and above that of corticosteroid or vitamin K used alone, in reducing the frequency and the degree of PIVH in premature newborns less than 35 weeks' gestation. All of these 280 pregnant women were randomly allocated into five groups according to the in-patient sequence. Group A (vitamin K1 group) including 38 pregnant women (40 newborns) received antenatal intramuscular or intravenously injection of vitamin K1 10 mg per day for 2-7 days. Group B (single dose corticosteroid group) including 57 pregnant women (63 newborns) received antenatal intramuscular or intravenously injection of dexamethasone 10 mg per day for 1 day. Group C (two dose corticosteroid group) including 62 pregnant women (70 newborns) received antenatal intramuscular or intravenously injection of dexamethasone 10 mg per day for 2 days. Group D (combined using dexamethasone and vitamin K1) including 41 pregnant women (44 newborns) received dexamethasone 10 mg per day for 1 day and vitamin K110 mg per day for 2-7 days. Control group, including 82 pregnant women (87 newborns) were received neither dexamethasone nor vitamin K1 injection. The results showed PIVH was diagnosed in 17 of 40 (42.5%) in Group A, 34 of 63 (54.0%) in Group B, 36 of 70 (51.4%) in Group C, 14 of 44 (31.8%) in Group D, and 57 of 87 (65.2%) in control infants (p = 0.004). More infants in the control group had grade III or IV intracranial hemorrhage after birth (p = 0.049). After antenatal supplement of dexamethasone and vitamin K1, both the total incidence of PIVH and the frequency of severe PIVH decreased significantly. The total and severe incidence of PIVH in Group B (single doses dexamethasone) and Group C (two courses dexamethasone) there were no significant difference. It showed that after antenatal supplement of dexamethasone and vitamin K1, both the total incidence of PIVH and the frequency of severe PIVH decreased significantly, and combined antenatal corticosteroid and vitamin K administration have much benefit, over and above that of corticosteroid or vitamin K used alone.
我们前瞻性评估了联合产前使用皮质类固醇和维生素K，相较于单独使用皮质类固醇或维生素K，在降低孕周小于35周的早产新生儿脑室内出血（PIVH）的发生率和严重程度方面是否具有额外益处。这280名孕妇均按照住院顺序被随机分为五组。A组（维生素K1组）包括38名孕妇（40名新生儿），接受产前每日肌肉注射或静脉注射维生素K1 10毫克，共2 - 7天。B组（单剂量皮质类固醇组）包括57名孕妇（63名新生儿），接受产前每日肌肉注射或静脉注射地塞米松10毫克，共1天。C组（两剂量皮质类固醇组）包括62名孕妇（70名新生儿），接受产前每日肌肉注射或静脉注射地塞米松10毫克，共2天。D组（地塞米松和维生素K1联合使用组）包括41名孕妇（44名新生儿），接受每日地塞米松10毫克共1天以及每日维生素K1 10毫克共2 - 7天。对照组包括82名孕妇（87名新生儿），既未接受地塞米松也未接受维生素K1注射。结果显示，A组40名中有17名（42.5%）被诊断为PIVH，B组中63名有34名（54.0%），C组70名中有36名（51.4%），D组44名中有14名（31.8%），对照组87名中有57名（65.2%）（p = 0.004）。对照组中更多婴儿出生后发生III级或IV级颅内出血（p = 0.049）。产前补充地塞米松和维生素K1后，PIVH的总发生率和重度PIVH的发生率均显著降低。B组（单剂量地塞米松）和C组（两疗程地塞米松）的PIVH总发生率和重度发生率无显著差异。结果表明，产前补充地塞米松和维生素K1后，PIVH的总发生率和重度PIVH的发生率均显著降低，联合产前使用皮质类固醇和维生素K相较于单独使用皮质类固醇或维生素K具有更多益处。
