Schmitz T
AP-HP, Hôpital Robert Debré, Service de Gynécologie Obstétrique, Paris, France.
Arch Pediatr. 2010 Sep;17 Suppl 3:S101-4. doi: 10.1016/S0929-693X(10)70908-8.
Because they might not be efficient in reducing neonatal morbidities associated with preterm birth after 7 days of exposure, antenatal corticosteroids have been systematically repeated every week or every 2 weeks in the late 90's. Evaluation of these strategies by randomized trials demonstrated, for the neonates exposed to multiple courses, short-term neonatal benefits, mainly pulmonary, but also alterations of fetal growth and potential impairments in neurodevelopmental outcomes, without benefits at 2 years of age. This is the reason why systematic repetitive doses of antenatal corticosteroids have been stopped and has emerged the concept of rescue course in which betamethasone is given only when delivery has again become likely. It can be concluded from the only two randomized trials having evaluated this strategy that antenatal corticosteroids rescue courses might be beneficial in reducing acute pulmonary morbidity, without noticeable effects on fetal growth. Scientific data suggesting the efficacy and innocuousness of antenatal corticosteroids rescue courses in the early neonatal period are now available, however, they should be further confirmed by new randomized trials and follow up studies before this strategy can be recommended for a daily clinical practice.
由于在暴露7天后，产前使用皮质类固醇可能无法有效降低与早产相关的新生儿发病率，因此在90年代后期，人们开始每周或每两周系统性地重复使用产前皮质类固醇。通过随机试验对这些策略进行评估发现，对于接受多疗程治疗的新生儿，短期内有一定益处，主要是肺部方面的，但也存在胎儿生长改变以及神经发育结局潜在受损的情况，且在2岁时并无益处。这就是系统性重复使用产前皮质类固醇已被停止的原因，并且出现了救援疗程的概念，即仅在再次有可能分娩时才给予倍他米松。从仅有的两项评估该策略的随机试验可以得出结论，产前皮质类固醇救援疗程可能有助于降低急性肺部发病率，对胎儿生长没有明显影响。目前已有科学数据表明产前皮质类固醇救援疗程在新生儿早期具有有效性和安全性，然而，在该策略被推荐用于日常临床实践之前，还需要新的随机试验和随访研究进一步证实。
