Goldstein Neal D, Kenaley Kaitlin M, Locke Robert, Paul David A
Department of Pediatrics, Christiana Care Health System, 4745 Ogletown-Stanton Road, MAP 1, Suite 116, Newark, DE, 19713, USA.
Value Institute, Christiana Care Health System, Newark, DE, USA.
Matern Child Health J. 2018 Mar;22(3):384-390. doi: 10.1007/s10995-017-2403-z.
Antenatal corticosteroids are standard of care for women at risk of a preterm birth and demonstrated to be protective against poor outcomes in neonates including respiratory disorders, mortality and intraventricular hemorrhage (IVH). Its benefits may vary by gestational age, and accurate estimation is needed in a single-center population to account for practice variation.
A retrospective cohort of infants admitted to the hospital's neonatal intensive care unit, 1997-2015. Using Poisson regression, we separately modeled the incidence rate ratio of death, grade III or IV intraventricular hemorrhage (IVH), and moderate to severe bronchopulmonary dysplasia (BPD) testing the moderating effects of gestation on antenatal steroids, controlling for potential confounding.
Among 5314 infants admitted, death occurred in 298 (6%), severe IVH in 244 (5%), and BPD in 527 (10%). Antenatal steroids were protective of death and BPD in the adjusted analysis, and there was multiplicative interaction where each week increase in gestational age combined with steroid therapy resulted in 13% reduced incidence for each outcome.
Antenatal steroids are protective against severe IVH and moderate to severe BPD, and when combined with gestational age, steroids are associated with greater protective benefits in older neonates. There is likely an ideal window to maximize the benefits of antenatal steroids, and future etiologic research should consider the joint effects with gestational age.
产前使用皮质类固醇是早产风险女性的标准治疗方法，已证明可预防新生儿的不良结局，包括呼吸系统疾病、死亡率和脑室内出血（IVH）。其益处可能因胎龄而异，因此需要在单中心人群中进行准确评估，以考虑实践差异。
对1997年至2015年入住医院新生儿重症监护病房的婴儿进行回顾性队列研究。使用泊松回归，我们分别对死亡、III级或IV级脑室内出血（IVH）以及中度至重度支气管肺发育不良（BPD）的发病率比进行建模，测试胎龄对产前类固醇的调节作用，并控制潜在的混杂因素。
在5314名入院婴儿中，298名（6%）死亡，244名（5%）发生严重IVH，527名（10%）发生BPD。在调整分析中，产前类固醇对死亡和BPD具有保护作用，并且存在相乘交互作用，即胎龄每增加一周与类固醇治疗相结合，每种结局的发病率降低13%。
产前类固醇可预防严重IVH和中度至重度BPD，并且与胎龄相结合时，类固醇对较大新生儿具有更大的保护益处。可能存在一个理想的窗口期来最大化产前类固醇的益处，未来的病因学研究应考虑与胎龄的联合效应。
