Travers Colm P, Carlo Waldemar A, McDonald Scott A, Das Abhik, Bell Edward F, Ambalavanan Namasivayam, Jobe Alan H, Goldberg Ronald N, D'Angio Carl T, Stoll Barbara J, Shankaran Seetha, Laptook Abbot R, Schmidt Barbara, Walsh Michele C, Sánchez Pablo J, Ball M Bethany, Hale Ellen C, Newman Nancy S, Higgins Rosemary D
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD.
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD; University of Alabama at Birmingham, Birmingham, AL.
Am J Obstet Gynecol. 2018 Jan;218(1):130.e1-130.e13. doi: 10.1016/j.ajog.2017.11.554. Epub 2017 Nov 11.
Antenatal corticosteroids are given primarily to induce fetal lung maturation but results from meta-analyses of randomized controlled trials have not shown mortality or pulmonary benefits for extremely preterm infants although these are the infants most at risk of mortality and pulmonary disease.
We sought to determine if exposure to antenatal corticosteroids is associated with a lower rate of death and pulmonary morbidities by 36 weeks' postmenstrual age.
Prospectively collected data on 11,022 infants 22 0/7 to 28 6/7 weeks' gestational age with a birthweight of ≥401 g born from Jan. 1, 2006, through Dec. 31, 2014, were analyzed. The rate of death and the rate of physiologic bronchopulmonary dysplasia by 36 weeks' postmenstrual age were analyzed by level of exposure to antenatal corticosteroids using models adjusted for maternal variables, infant variables, center, and epoch.
Infants exposed to any antenatal corticosteroids had a lower rate of death (2193/9670 [22.7%]) compared to infants without exposure (540/1302 [41.5%]) (adjusted relative risk, 0.71; 95% confidence interval, 0.65-0.76; P < .0001). Infants exposed to a partial course of antenatal corticosteroids also had a lower rate of death (654/2520 [26.0%]) compared to infants without exposure (540/1302 [41.5%]); (adjusted relative risk, 0.77; 95% confidence interval, 0.70-0.85; P < .0001). In an analysis by each week of gestation, infants exposed to a complete course of antenatal corticosteroids had lower mortality before discharge compared to infants without exposure at each week from 23-27 weeks' gestation and infants exposed to a partial course of antenatal corticosteroids had lower mortality at 23, 24, and 26 weeks' gestation. Rates of bronchopulmonary dysplasia in survivors did not differ by antenatal corticosteroid exposure. The rate of death due to respiratory distress syndrome, the rate of surfactant use, and the rate of mechanical ventilation were lower in infants exposed to any antenatal corticosteroids compared to infants without exposure.
Among infants 22-28 weeks' gestational age, any or partial antenatal exposure to corticosteroids compared to no exposure is associated with a lower rate of death while the rate of bronchopulmonary dysplasia in survivors did not differ.
产前使用糖皮质激素主要是为了促进胎儿肺成熟，但随机对照试验的荟萃分析结果显示，对于极早产儿而言，其死亡率和肺部疾病并未得到改善，尽管这些婴儿是死亡和肺部疾病的高危人群。
我们试图确定在孕龄36周时，产前接触糖皮质激素是否与较低的死亡率和肺部疾病发生率相关。
对2006年1月1日至2014年12月31日期间出生的11,022例孕龄在22⁰/₇至28⁶/₇周、出生体重≥401 g的婴儿进行前瞻性数据收集并分析。采用针对母亲变量、婴儿变量、中心和时期进行调整的模型，根据产前糖皮质激素暴露水平分析孕龄36周时的死亡率和生理性支气管肺发育不良的发生率。
与未接触产前糖皮质激素的婴儿（540/1302 [41.5%]）相比，接触过任何产前糖皮质激素的婴儿死亡率较低（2193/9670 [22.7%]）（校正相对风险，0.71；95%置信区间，0.65 - 0.76；P <.0001）。与未接触的婴儿（540/1302 [41.5%]）相比，接受部分疗程产前糖皮质激素治疗的婴儿死亡率也较低（654/2520 [26.0%]）；（校正相对风险，0.77；95%置信区间，0.70 - 0.85；P <.0001）。在按孕周进行的分析中，与未接触的婴儿相比，在孕23 - 27周的每周中，接受完整疗程产前糖皮质激素治疗的婴儿出院前死亡率较低，接受部分疗程产前糖皮质激素治疗的婴儿在孕23、24和26周时死亡率较低。存活者的支气管肺发育不良发生率在产前糖皮质激素暴露组之间没有差异。与未接触的婴儿相比，接触过任何产前糖皮质激素的婴儿因呼吸窘迫综合征导致的死亡率、使用表面活性物质的比例和机械通气的比例较低。
在孕龄22 - 28周的婴儿中，与未接触相比，产前接触任何剂量或部分剂量的糖皮质激素与较低的死亡率相关，而存活者的支气管肺发育不良发生率没有差异。
