产前皮质类固醇对早产双胞胎的疗效：EPIPAGE-2 队列研究。
Efficacy of antenatal corticosteroids in preterm twins: the EPIPAGE-2 cohort study.
机构信息
IMR 1027 INSERM, Team SPHERE, Toulouse III University, Toulouse, France.
Department of Medical Information, Albi Hospital, Albi, France.
出版信息
BJOG. 2018 Aug;125(9):1164-1170. doi: 10.1111/1471-0528.15014. Epub 2017 Dec 14.
OBJECTIVES
To investigate the efficacy of antenatal corticosteroid (ACS) therapy on short-term neonatal outcomes in preterm twins, and further document the influence of the ACS-to-delivery interval.
DESIGN
EPIPAGE-2 is a nationwide observational multicentre prospective cohort study of neonates born between 22 and 34 completed weeks of gestation.
SETTING
All French maternity units, except in a single administrative region, between March and December 2011.
POPULATION
A total of 750 twin neonates born between 24 and 31 weeks of gestation.
METHODS
Exposure to ACSs was examined in four groups: single complete course, with an ACS administration-to-delivery interval of ≤7 days; single complete course, with an ACS-to-delivery interval of >7 days; repeated courses; or no ACS treatment.
MAIN OUTCOME MEASURES
Neonatal outcomes analysed were severe bronchopulmonary dysplasia, periventricular leukomalacia or intraventricular haemorrhage grade III/IV, in-hospital mortality, and a composite indicator of severe outcomes.
RESULTS
Compared with no ACSs, in multivariable analysis, a single course of ACSs with an administration-to-delivery interval of ≤7 days was significantly associated with a reduced rate of periventricular leukomalacia or intraventricular haemorrhage grade III/IV (aOR 0.2; CI 95% 0.1-0.5), in-hospital mortality (0.3; 0.1-0.6), and the composite indicator (0.1; 0.1-0.3), whereas a single course of ACDs with an administration-to-delivery interval of >7 days did not significantly reduce the frequency of in-hospital mortality (0.7; 0.3-1.8). No significant differences in terms of benefit or risk were found when comparing repeated courses with a single complete course.
CONCLUSION
In preterm twins, a single complete course of antenatal corticosteroids was associated with an improvement of severe neurological outcome, whereas reduced in-hospital mortality was seen only when the ACS-to-delivery interval was ≤7 days.
TWEETABLE ABSTRACT
A single complete course of antenatal steroids reduced severe neurological morbidity in preterm twins (24-31 weeks).
目的
研究产前皮质类固醇（ACS）治疗对早产儿短期新生儿结局的疗效，并进一步记录 ACS 至分娩间隔的影响。
设计
EPIPAGE-2 是一项全国性的观察性多中心前瞻性队列研究，研究对象为 22 至 34 周妊娠足月的新生儿。
地点
2011 年 3 月至 12 月期间，除了一个行政区域外，法国所有的产科单位。
人群
共有 750 例 24 至 31 周妊娠的双胞胎新生儿。
方法
在以下四组中检查 ACS 暴露情况：单次完整疗程，ACS 给药至分娩间隔≤7 天；单次完整疗程，ACS 给药至分娩间隔>7 天；重复疗程；或未接受 ACS 治疗。
主要观察指标
分析的新生儿结局包括严重支气管肺发育不良、脑室周围白质软化或脑室内出血 3/4 级、院内死亡率和严重结局的综合指标。
结果
与未接受 ACS 治疗相比，多变量分析显示，ACS 给药至分娩间隔≤7 天的单疗程治疗与脑室周围白质软化或脑室内出血 3/4 级（aOR 0.2；95%CI 0.1-0.5）、院内死亡率（0.3；0.1-0.6）和综合指标（0.1；0.1-0.3）的发生率降低显著相关，而 ACS 给药至分娩间隔>7 天的单疗程治疗与院内死亡率（0.7；0.3-1.8）的降低无显著相关性。重复疗程与单疗程相比，在获益或风险方面没有发现显著差异。
结论
在早产儿中，单次完整疗程的产前皮质类固醇治疗与严重神经结局的改善相关，而只有当 ACS 至分娩间隔≤7 天时，才会降低院内死亡率。
推文摘要
在早产儿中，单次完整疗程的产前类固醇治疗可降低严重神经发育不良的发生率。
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