Miyazaki Ken, Furuhashi Madoka, Ishikawa Kaoru, Tamakoshi Koji, Hayashi Kazutoshi, Kai Akihiro, Ishikawa Hiroshi, Murabayashi Nao, Ikeda Tomoaki, Kono Yumi, Kusuda Satoshi, Fujimura Masanori
Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya Daiichi Hospital, 3-15 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
Department of Endowed Chair for Regeneration of Medicine in Kuwana District, Suzuka University of Medical Science, Mie, Japan.
Arch Gynecol Obstet. 2015 Dec;292(6):1239-46. doi: 10.1007/s00404-015-3762-6. Epub 2015 May 20.
To evaluate the effect of antenatal corticosteroids (AC) therapy on short- and long-term outcomes among very low birth weight preterm infants after histologic chorioamnionitis (HCA).
We performed a retrospective analysis of 5240 single very low birth weight (VLBW) infants born at 22 + 0 and 33 + 6 weeks of gestation between 2003 and 2007, who registered to the Neonatal Research Network Japan. The effects of AC therapy on mortality, neurodevelopmental outcomes at 3 years of age and neonatal morbidities were analyzed in the groups with or without HCA using logistic regression analysis.
In the study subjects, 840 were with HCA, 2734 were without HCA, and 1666 were excluded without data for HCA. AC therapy was significantly associated with decreasing mortality before 3 years of age; [0.52 (0.32-0.86)], [odds ratio (95 % confidence intervals]. There were no differences between the two groups regarding neurodevelopmental outcomes, including cerebral palsy [0.90 (0.41-1.99)], development quotient <70 [0.93 (0.48-1.81)], visual impairment [0.46 (0.04-5.18)], and severe hearing impairment [4.00 (0.30-53.4)] in the group with HCA as well as without HCA. Regarding neonatal morbidities, AC therapy was associated with a lower incidence of respiratory distress syndrome [0.67 (0.50-0.91)], sepsis [0.62 (0.41-0.94)], late-onset adrenal insufficiency [0.62 (0.39-0.98)] and an increased incidence of chronic lung disease [1.62 (1.18-2.24)] in the group with HCA. In the group without HCA, AC therapy was associated with decreasing respiratory distress syndrome [0.60 (0.43-0.84)] and increasing chronic lung disease [1.34 (1.11-1.62)].
AC therapy is significantly associated with reduced mortality before 3 years of age in VLBW infants with HCA, but not with neurodevelopmental outcomes, which was same as the results found in infants without HCA. AC therapy is recommended for women with suspected chorioamnionitis, as well as those without chorioamnionitis.
评估产前使用糖皮质激素（AC）治疗对组织学绒毛膜羊膜炎（HCA）后极低出生体重早产儿短期和长期预后的影响。
我们对2003年至2007年间在日本新生儿研究网络登记的5240例孕22 + 0至33 + 6周出生的单胎极低出生体重（VLBW）婴儿进行了回顾性分析。采用逻辑回归分析，比较有无HCA组中AC治疗对死亡率、3岁时神经发育结局及新生儿疾病的影响。
在研究对象中，840例有HCA，2734例无HCA，1666例因无HCA数据被排除。AC治疗与3岁前死亡率降低显著相关；[0.52（0.32 - 0.86）]，[比值比（95%置信区间）]。两组在神经发育结局方面无差异，包括HCA组和无HCA组的脑瘫[0.90（0.41 - 1.99）]、发育商<70[0.93（0.48 - 1.81）]、视力障碍[0.46（0.04 - 5.18）]和重度听力障碍[4.00（0.30 - 53.4）]。关于新生儿疾病，HCA组中AC治疗与呼吸窘迫综合征发生率较低[0.67（0.50 - 0.91）]、败血症[0.62（0.41 - 0.94）]、迟发性肾上腺功能不全[0.62（0.39 - 0.98）]相关，慢性肺病发生率增加[1.62（1.18 - 2.24）]；在无HCA组中，AC治疗与呼吸窘迫综合征发生率降低[0.60（0.43 - 0.84）]和慢性肺病发生率增加[1.34（1.11 - 1.62）]相关。
AC治疗与HCA的VLBW婴儿3岁前死亡率降低显著相关，但与神经发育结局无关，这与无HCA婴儿的结果相同。建议对疑似绒毛膜羊膜炎的女性以及无绒毛膜羊膜炎的女性使用AC治疗。
