Deshmukh Mangesh, Patole Sanjay
Department of Neonatal Pediatrics, St. John of God Hospital, Subiaco, Perth, Western Australia.
Department of Neonatal Pediatrics, Fiona Stanley Hospital, Perth, Western Australia.
PLoS One. 2017 May 9;12(5):e0176090. doi: 10.1371/journal.pone.0176090. eCollection 2017.
Efficacy of antenatal corticosteroids before 25 weeks of gestation is unclear.
To assess and compare neonatal outcomes following ANC exposure at 22, 23 and 24 weeks of gestation by conducting systematic review and meta- analysis.
A systematic review of randomised controlled trials (RCT) and non-RCTs reporting on neonatal outcomes after exposure to ANC up to 246 weeks of gestation using the Cochrane systematic review methodology. Databases Pubmed, CINAHL, Embase, Cochrane Central library, and online abstracts of conference proceedings including the Pediatric Academic Society (PAS) were searched in Feb 2017. Primary outcome was in-hospital mortality defined as death before discharge during the first admission. Secondary outcomes included severe intraventricular hemorrhage (IVH> grade III and IV)/or periventricular leukomalacia (PVL), necrotising enterocolitis (NEC >stage II) and chronic lung disease (CLD). Meta-analysis was performed using a random-effects model. The level of evidence (LOE) was summarised using the GRADE guidelines.
There were no RCTs; 8 high quality non-RCTs were included in the review. Meta-analysis showed reduction in mortality [N = 10109; OR = 0.47(0.39-0.56), p<0.00001; LOE: Moderate] and severe IVH and PVL [N = 5084; OR = 0.71(0.61-0.82), p<0.00001; LOE: Low] after exposure to ANC in neonates born <25 weeks. There was no significant difference in CLD [N = 4649; OR = 1.19(0.85-1.65) p = 0.31; LOE: Low] and NEC [N = 5403; OR = 0.95 (0.76-1.19) p = 0.65; LOE: Low]. Mortality was comparable in neonates born at 22, 23 or 24 weeks.
Moderate to low quality evidence indicates that exposure to ANC is associated with reduction in mortality and IVH/or PVL in neonates born before 25 weeks.
妊娠25周前使用产前糖皮质激素的疗效尚不清楚。
通过系统评价和荟萃分析，评估并比较妊娠22、23和24周时暴露于产前糖皮质激素后的新生儿结局。
采用Cochrane系统评价方法，对报告妊娠24周内暴露于产前糖皮质激素后新生儿结局的随机对照试验（RCT）和非随机对照试验进行系统评价。2017年2月检索了数据库PubMed、CINAHL、Embase、Cochrane中央图书馆以及包括儿科学术协会（PAS）会议论文集在内的在线摘要。主要结局为住院死亡率，定义为首次入院期间出院前死亡。次要结局包括重度脑室内出血（IVH>III级和IV级）和/或脑室周围白质软化（PVL）、坏死性小肠结肠炎（NEC>II期）和慢性肺病（CLD）。采用随机效应模型进行荟萃分析。使用GRADE指南总结证据水平（LOE）。
未检索到RCT；纳入该评价的有8项高质量非随机对照试验。荟萃分析显示，妊娠<25周出生的新生儿暴露于产前糖皮质激素后，死亡率降低[N = 10109；OR = 0.47（0.39 - 0.56），p<0.00001；LOE：中等]，重度IVH和PVL发生率降低[N = 5084；OR = 0.71（0.61 - 0.82），p<0.00001；LOE：低]。CLD[N = 4649；OR = 1.19（0.85 - 1.65），p = 0.31；LOE：低]和NEC[N = 5403；OR = 0.95（0.76 - 1.19），p = 0.65；LOE：低]无显著差异。妊娠22、23或24周出生的新生儿死亡率相当。
中低质量证据表明，妊娠25周前出生的新生儿暴露于产前糖皮质激素与死亡率降低以及IVH和/或PVL发生率降低相关。
