Hayes Edward J, Paul David A, Stahl Gary E, Seibel-Seamon Jolene, Dysart Kevin, Leiby Benjamin E, Mackley Amy B, Berghella Vincenzo
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Obstet Gynecol. 2008 Apr;111(4):921-6. doi: 10.1097/AOG.0b013e318169ce2d.
To estimate if exposure to antenatal corticosteroids was associated with decreased rate of death in neonates born at 23 weeks of gestation.
This is a retrospective cohort study performed at three tertiary centers of neonates born at 23 weeks of gestation between 1998 and 2007. Stillbirths, voluntary terminations, or parental elected nonresuscitations were excluded. Clinical and demographic variables were examined to determine possible confounding variables. A multivariable logistic regression model was used to assess the effect of steroids on the odds of death after adjustment for these confounders.
The sample included 181 neonates. Of the multiple variables examined (institution, race, diagnosis, illicit drug use, antibiotics, assisted reproduction, birth weight, gender, and route of delivery), only multiple gestations were significantly associated (P<or=.15) with steroid use and increased odds of death (odds ratio [OR] 3.66, 95% confidence interval [CI] 1.05-12.73) and controlled for in the final model. The multivariable model revealed those exposed to antenatal corticosteroids had decreased odds of death (OR 0.32, 95% CI 0.12-0.84), with no significant differences in the occurrence of necrotizing enterocolitis among survivors (15.4% compared with 28.6%, P=.59) or severe intraventricular hemorrhage (23.1% compared with 57.1%, P=.17). In analyzing the effect of steroid dose, only a complete course of corticosteroids was associated with a decreased odds of death (OR 0.18, 95% CI 0.06-0.54).
Neonates at 23 weeks of gestation whose mothers completed a course of antenatal corticosteroids had an associated 82% reduction in odds of death.
评估产前使用皮质类固醇激素是否与孕23周出生的新生儿死亡率降低有关。
这是一项回顾性队列研究，在1998年至2007年间于三个三级医疗中心对孕23周出生的新生儿进行。排除死产、自愿终止妊娠或父母选择不复苏的情况。检查临床和人口统计学变量以确定可能的混杂变量。使用多变量逻辑回归模型评估在调整这些混杂因素后类固醇对死亡几率的影响。
样本包括181名新生儿。在所检查的多个变量（机构、种族、诊断、非法药物使用、抗生素、辅助生殖、出生体重、性别和分娩途径）中，只有多胎妊娠与类固醇使用显著相关（P≤0.15），且死亡几率增加（优势比[OR]3.66，95%置信区间[CI]1.05 - 12.73），并在最终模型中进行了控制。多变量模型显示，产前使用皮质类固醇激素的新生儿死亡几率降低（OR 0.32，95% CI 0.12 - 0.84），幸存者中坏死性小肠结肠炎的发生率无显著差异（15.4% 对比 28.6%，P = 0.59）或重度脑室内出血（23.1% 对比 57.1%，P = 0.17）。在分析类固醇剂量的影响时，只有完整疗程的皮质类固醇激素与死亡几率降低相关（OR 0.18，95% CI 0.06 - 0.54）。
孕23周的新生儿，其母亲完成一个疗程产前皮质类固醇激素治疗后，死亡几率降低了82%。
