Department of Paediatrics, Maastricht University Medical Centre, the Netherlands.
BJOG. 2011 Jan;118(2):113-22. doi: 10.1111/j.1471-0528.2010.02751.x. Epub 2010 Nov 4.
There is debate concerning the safety and efficacy of antenatal steroids in preterm labour with suspected intrauterine infection (chorioamnionitis).
We performed a systematic literature review and meta-analysis aimed at evaluating the efficacy and safety of antenatal steroids in clinical and histological chorioamnionitis.
MEDLINE, EMBASE, BioMed Central and the Cochrane databases were searched using the terms 'chorioamnionitis OR intrauterine infection' and '*steroids OR *corticoids'.
Studies that reported selected neonatal outcome measures in preterm infants with clinical or histological chorio-amnionitis, according to antenatal steroid exposure, were eligible.
Study selection, data extraction and data analysis were performed by two independent investigators. The meta-analysis techniques used included: Mantel-Haenszel analysis; an assessment of study heterogeneity using the Q statistic; and Egger's regression test and funnel plots, to assess publication bias.
Seven observational studies were included. In histological chorioamnionitis (five studies), antenatal steroids were associated with reduced mortality (OR = 0.45; 95% CI = 0.30-0.68; P = 0.0001), respiratory distress syndrome (OR = 0.53; 95% CI = 0.40-0.71; P < 0.0001), patent ductus arteriosus (OR = 0.56; 95% CI = 0.37-0.85; P = 0.007), intraventricular haemorrhage (IVH; OR = 0.35; 95% CI = 0.18-0.66; P = 0.001) and severe IVH (OR = 0.39; 95% CI = 0.19-0.82; P = 0.01). In clinical chorioamnionitis (four studies), antenatal steroids were associated with reduced severe IVH (OR = 0.29; 95% CI = 0.10-0.89; P = 0.03) and periventricular leucomalacia (OR = 0.35; 95% CI = 0.14-0.85; P = 0.02).
Antenatal steroids may be safe and reduce adverse neonatal outcome after preterm birth associated with chorioamnionitis. There is a need for randomised clinical trials to address this issue.
对于疑似宫内感染（绒毛膜羊膜炎）的早产，产前类固醇的安全性和疗效存在争议。
我们进行了系统的文献回顾和荟萃分析，旨在评估产前类固醇在临床和组织学绒毛膜羊膜炎中的疗效和安全性。
使用“绒毛膜羊膜炎或宫内感染”和“类固醇或*皮质激素”这两个术语，在 MEDLINE、EMBASE、生物医学中心和 Cochrane 数据库中进行了检索。
符合产前类固醇暴露的临床或组织学绒毛膜羊膜炎早产儿的选择新生儿结局指标的研究均符合入选标准。
由两位独立的研究人员进行研究选择、数据提取和数据分析。使用的荟萃分析技术包括：Mantel-Haenszel 分析；使用 Q 统计量评估研究异质性；Egger 回归检验和漏斗图，以评估发表偏倚。
纳入了 7 项观察性研究。在组织学绒毛膜羊膜炎（5 项研究）中，产前类固醇与死亡率降低相关（OR=0.45；95%CI=0.30-0.68；P=0.0001）、呼吸窘迫综合征（OR=0.53；95%CI=0.40-0.71；P<0.0001）、动脉导管未闭（OR=0.56；95%CI=0.37-0.85；P=0.007）、脑室内出血（IVH；OR=0.35；95%CI=0.18-0.66；P=0.001）和严重 IVH（OR=0.39；95%CI=0.19-0.82；P=0.01）。在临床绒毛膜羊膜炎（4 项研究）中，产前类固醇与严重 IVH 降低相关（OR=0.29；95%CI=0.10-0.89；P=0.03）和脑室周围白质软化（OR=0.35；95%CI=0.14-0.85；P=0.02）。
产前类固醇可能是安全的，并可降低与绒毛膜羊膜炎相关的早产不良新生儿结局。需要进行随机临床试验来解决这个问题。
