Pérez-Ramírez Rene O, Lona-Reyes Juan Carlos, Ochoa-Meza Cesar A, Gómez-Ruiz Larissa M, Ramos-Gutiérrez Ruth Y, Camarena-Pulido E Elizabeth, Gallegos-Marín J Antonio
Hospital Civil de Guadalajara Dr. Juan I. Menchaca, División de Pediatría, Guadalajara, Jalisco, México.
Hospital Civil de Guadalajara Dr. Juan I. Menchaca, División de Pediatría, Guadalajara, Jalisco, México; Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, México.
An Pediatr (Engl Ed). 2019 Aug;91(2):105-111. doi: 10.1016/j.anpedi.2018.11.011. Epub 2019 Jan 3.
Prenatal corticosteroids reduce neonatal mortality and morbidity; however, there are few studies in developing countries, and with inconsistent results. The purpose of this study was to quantify the frequency of the use of prenatal corticosteroids and to estimate its effect on the morbidity and mortality of premature newborns.
A retrospective cohort study was performed on premature newborns selected from a census conducted between January 2016 and August 2017. The use of corticosteroids was taken from the maternal records, and the dependent variables from the neonatal records. An analysis was made of the relationship using logistic regression, adjusted to gestational age and weight.
The study included 1083 premature infants of which 53.3% were male. The mean gestational age was 33.4 weeks. Corticosteroids were received by 42%, with latency ≥24hours in 23.6% and ≥48hours in 13.8%. Respiratory distress syndrome was observed in 35% (379/1083), early neonatal sepsis in 4.4% (48/1083), late neonatal sepsis in 10.7% (116/1083), intraventricular haemorrhage in 15.1% (137/908), chronic lung disease in 51.4% (165/321), and death in 22.3% (242/1083). Prenatal corticosteroids decreased the risk of death in children under 34 weeks (OR 0.63, 95% CI 0.40-0.98). The decrease was greater if they presented with latency ≥48hours (OR 0.40, 95% CI 0.20-0.80). The rest of the dependent variables were not modified by the intervention.
In preterm infants, 42% received antenatal corticosteroids. In those with less than 34 weeks, there was a decrease in the risk of death without changes in morbidity.
产前使用皮质类固醇可降低新生儿死亡率和发病率；然而，发展中国家对此的研究较少，且结果不一致。本研究旨在量化产前皮质类固醇的使用频率，并评估其对早产新生儿发病率和死亡率的影响。
对2016年1月至2017年8月间普查选取的早产新生儿进行回顾性队列研究。皮质类固醇的使用情况取自母亲记录，因变量取自新生儿记录。采用逻辑回归分析两者关系，并根据胎龄和体重进行调整。
该研究纳入1083例早产婴儿，其中53.3%为男性。平均胎龄为33.4周。42%的婴儿接受了皮质类固醇治疗，其中潜伏期≥24小时的占23.6%，≥48小时的占13.8%。观察到35%（379/1083）的婴儿患有呼吸窘迫综合征，4.4%（48/1083）的婴儿患有早发性新生儿败血症，10.7%（116/1083）的婴儿患有晚发性新生儿败血症，15.1%（137/908）的婴儿患有脑室内出血，51.4%（165/321）的婴儿患有慢性肺病，22.3%（242/1083）的婴儿死亡。产前使用皮质类固醇降低了34周以下儿童的死亡风险（比值比0.63，95%置信区间0.40 - 0.98）。如果潜伏期≥48小时，死亡风险降低更显著（比值比0.40，95%置信区间0.20 - 0.80）。其余因变量未因该干预措施而改变。
在早产儿中，42%接受了产前皮质类固醇治疗。在胎龄小于34周的婴儿中，死亡风险降低，发病率未发生变化。
