Sandesh Kiran P S, Dutta Sourabh, Narang Anil, Bhansali Anil, Malhi Prahbhjot
Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Pediatr. 2007 May;74(5):463-9. doi: 10.1007/s12098-007-0079-x.
The benefits and risks of multiple courses of antenatal steroids (ANS) are still unresolved issues. This was a prospective cohort study in a level III neonatal unit. Preterm babies < or = 35 wk gestation were included. Malformations, chronic maternal steroid intake, exchange transfusions prior to cortisol sampling and incomplete ANS courses were exclusion criteria. Subjects were classified into: No course (Group 0), 1 course (group 1), 2 courses (Group 2), > 2 courses (Group 3) of antenatal dexamethasone. The key outcome was adrenal function assessed by basal and post-ACTH cortisol on day 3. Other outcomes were neonatal morbidity, mortality, growth parameters at birth, long term growth and neuro-development. Of 210 eligible babies, 124 were enrolled. 38, 51, 10 and 25 babies belonged to groups 0, 1, 2 and 3 respectively. Basal and post-ACTH serum cortisol did not show any significant difference between groups (p=0.5 and p=0.9 respectively). Incidence of severe HMD requiring ventilation was significantly lower (p=0.02) in multiple course group (combined groups 2 and 3) compared to single course group. There were no differences in other neonatal morbidity, birth OFC and weight between single and multiple ANS groups. Follow up data at a mean age of 22 mth was available in 59 subjects (69%) belonging to groups 1-3. No differences were noted in the proportion of patients with abnormal neurological examination (p=0.1), abnormal PDI (p=0.9), abnormal MDI (p=0.9) and physical growth between multiple and single course groups. Multiple courses of antenatal dexamethasone resulted in a significant decrease in severe forms of RDS and they did not cause adrenal suppression, decreased growth or impaired neuro-development.
多疗程产前类固醇（ANS）的益处和风险仍是未解决的问题。这是一项在三级新生儿病房进行的前瞻性队列研究。纳入妊娠≤35周的早产儿。畸形、母亲长期服用类固醇、在采集皮质醇样本前进行换血以及产前类固醇疗程不完整为排除标准。将研究对象分为：未接受疗程（0组）、1个疗程（1组）、2个疗程（2组）、>2个疗程（3组）的产前地塞米松。主要结局是在第3天通过基础和促肾上腺皮质激素刺激后的皮质醇评估肾上腺功能。其他结局包括新生儿发病率、死亡率、出生时的生长参数、长期生长和神经发育。在210名符合条件的婴儿中，124名被纳入研究。分别有38、51、10和25名婴儿属于0组、1组、2组和3组。各组之间基础和促肾上腺皮质激素刺激后的血清皮质醇无显著差异（分别为p = 0.5和p = 0.9）。与单疗程组相比，多疗程组（2组和3组合并）中需要通气的严重呼吸窘迫综合征（HMD）的发生率显著降低（p = 0.02）。单疗程和多疗程产前类固醇组在其他新生儿发病率、出生时的枕额径（OFC）和体重方面没有差异。对属于1 - 至3组的59名受试者（69%）进行了平均年龄为22个月的随访。多疗程组和单疗程组在神经检查异常（p = 0.1）、心理发育指数（PDI）异常（p = 0.9）、运动发育指数（MDI）异常（p = 0.9）以及身体生长方面的患者比例没有差异。多疗程产前地塞米松可显著降低严重形式的呼吸窘迫综合征（RDS），且不会导致肾上腺抑制、生长减缓或神经发育受损。
