Foix-L'Hélias L, Marret S, Ancel P-Y, Marchand L, Arnaud C, Fresson J, Picaud J-C, Rozé J-C, Theret B, Burguet A, Larroque B, Kaminski M
Inserm, UMR S149, Research Unit on Perinatal Health and Women's Health, Villejuif, France.
BJOG. 2008 Jan;115(2):275-82. doi: 10.1111/j.1471-0528.2007.01566.x.
To assess the impact of antenatal corticosteroids (ACS) on neonatal mortality, cerebral lesions and 5-year neurodevelopmental outcome of infants born at 24-27 and 28-32 weeks of gestational age (GA).
Observational population-based study including all births at GAs between 22 and 32 weeks in 1997 in nine regions of France. Survivors were assessed at the age of 5 years.
The population enrolled in the follow up comprised 2323 infants; there were 23 deaths before age 5 years and outcome at 5 years was available for up to 1781 subjects. Two GA subgroups (24-27 and 28-32 weeks of GA) were analysed separately. Propensity scores were used to reduce bias in the estimation of the association between ACS treatment and outcomes.
Neonatal death, neonatal white matter injury, cerebral palsy, mental processing composite (MPC) of the Kaufman Assessment Battery for Children test and behavioural difficulties at 5 years.
In the 28- to 32-week GA subgroup, there was a significant association between ACS and a decreased risk of both neonatal death (OR = 0.61 [0.41-0.91]) and white matter injury (OR = 0.60 [0.46-0.79]) but only a nonsignificant trend for improved 5-year outcome (cerebral palsy, MPC < 70). In the 24- to 27-week GA subgroup, ACS was associated with a significant decrease risk of neonatal death (OR = 0.43 [0.27-0.68]) but there was only a trend for a lower risk of white matter injury and no beneficial impact on outcome at 5 years. Limiting the analysis to only those who received complete courses of ACS did not modify the results.
The study shows that ACS therapy greatly increases the survival of very preterm infants, including the most immature, but there is little evidence that ACS affects long-term neurodevelopmental and behavioural outcome in 28- to 32-week survivors, and none in <28-week survivors.
评估产前使用糖皮质激素（ACS）对孕24 - 27周和28 - 32周出生婴儿的新生儿死亡率、脑损伤及5岁时神经发育结局的影响。
基于人群的观察性研究，纳入1997年法国9个地区孕22至32周的所有出生婴儿。对幸存者在5岁时进行评估。
纳入随访的人群包括2323名婴儿；5岁前有23例死亡，5岁时的结局数据可得的受试者达1781名。将两个孕周亚组（孕24 - 27周和孕28 - 32周）分别进行分析。采用倾向评分法以减少ACS治疗与结局之间关联估计中的偏倚。
新生儿死亡、新生儿白质损伤、脑性瘫痪、考夫曼儿童能力评估测验的心理加工综合得分（MPC）以及5岁时的行为困难。
在孕28至32周亚组中，ACS与新生儿死亡风险降低（比值比[OR]=0.61[0.41 - 0.91]）和白质损伤风险降低（OR = 0.60[0.46 - 0.79]）均显著相关，但5岁时结局改善（脑性瘫痪、MPC < 70）仅呈非显著趋势。在孕24至27周亚组中，ACS与新生儿死亡风险显著降低相关（OR = 0.43[0.27 - 0.68]），但白质损伤风险降低仅呈趋势，且对5岁时的结局无有益影响。将分析仅限于那些接受了完整疗程ACS治疗的婴儿，结果未改变。
该研究表明，ACS治疗极大地提高了极早产儿（包括最不成熟的婴儿）的存活率，但几乎没有证据表明ACS会影响孕28至32周幸存者的长期神经发育和行为结局，对于孕28周以下的幸存者则无影响。
