Seth Rakesh, Gray Peter H, Tudehope David I
Division of Neonatology, Mater Mothers' Hospital, University of Queensland, Qld., Australia.
Neonatology. 2009;95(2):172-8. doi: 10.1159/000153102. Epub 2008 Sep 6.
Postnatal corticosteroids are effective in preventing chronic lung disease in preterm infant. There are concerns that corticosteroid use may be associated with an increased risk of impaired neurodevelopment.
To examine the effect of change in practice with the use of postnatal corticosteroids over an 8-year period in extremely preterm babies on the incidence of chronic lung disease (CLD) and cerebral palsy at 1 year of age.
Babies of birth weight <1,000 g or gestational age <28 weeks admitted from 1997 to 2004 were included in this retrospective analysis. The study period was divided into two eras: group 1: 1997-2000, group 2: 2001-2004. Data were collected from the neonatal database, individual records and from the Growth and Development Unit. The outcome measure of CLD was defined as oxygen dependency at 36 weeks postmenstrual age. Data for postnatal corticosteroid usage were collected for the number of babies per year, and total dose.
389 group 1 babies were compared to 368 group 2 babies. There was a significant decrease in the use of dexamethasone from 27% in group 1 to 13% in group 2 (p = 0.0001), and total dose - mg/kg (4.5 +/- 2.9 vs. 2.6 +/- 1.6, p = 0.0001). The incidence of CLD and need for home oxygen was similar between groups. The incidence of cerebral palsy reduced from 10.4% in group 1 to 6.6% in group 2, though this was not statistically significant (OR 0.63; 95% CI 0.3, 1.2.).
Decreased postnatal corticosteroid use had no impact on the incidence of CLD or need for home oxygen therapy. The trend towards a reduced rate of cerebral palsy requires further investigation.
产后使用皮质类固醇对预防早产儿慢性肺病有效。有人担心使用皮质类固醇可能会增加神经发育受损的风险。
研究8年间在极早产儿中产后皮质类固醇使用情况的变化对1岁时慢性肺病（CLD）发病率和脑瘫发病率的影响。
本回顾性分析纳入了1997年至2004年出生体重<1000g或胎龄<28周的婴儿。研究期分为两个阶段：第1组：1997 - 2000年，第2组：2001 - 2004年。数据从新生儿数据库、个人记录以及生长发育科室收集。CLD的结局指标定义为孕龄36周时的氧依赖情况。收集每年使用产后皮质类固醇的婴儿数量及总剂量的数据。
第1组389名婴儿与第2组368名婴儿进行比较。地塞米松的使用从第1组的27%显著降至第2组的13%（p = 0.0001），总剂量 - mg/kg（4.5±2.9对比2.6±1.6，p = 0.0001）。两组间CLD的发病率及家庭氧疗需求相似。脑瘫发病率从第1组的10.4%降至第2组的6.6%，尽管无统计学意义（OR 0.63；95%CI 0.3，1.2）。
产后皮质类固醇使用减少对CLD发病率或家庭氧疗需求无影响。脑瘫发病率降低的趋势需要进一步研究。
