产前皮质类固醇使用与极早产儿复苏的不一致性。
Discordance in Antenatal Corticosteroid Use and Resuscitation Following Extremely Preterm Birth.
机构信息
Department of Pediatrics, University of Iowa, Iowa City, IA.
Department of Pediatrics, University of Iowa, Iowa City, IA.
出版信息
J Pediatr. 2019 May;208:156-162.e5. doi: 10.1016/j.jpeds.2018.12.063. Epub 2019 Feb 6.
OBJECTIVE
To describe discordance in antenatal corticosteroid use and resuscitation following extremely preterm birth and its relationship with infant survival and neurodevelopment.
STUDY DESIGN
A multicenter cohort study of 4858 infants 22-26 weeks of gestation born 2006-2011 at 24 US hospitals participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, with follow-up through 2013. Survival and neurodevelopmental outcomes were available at 18-22 months of corrected age for 4576 (94.2%) infants. We described antenatal interventions, resuscitation, and infant outcomes. We modeled the effect on infant outcomes of each hospital increasing antenatal corticosteroid exposure for resuscitated infants born at 22-24 weeks of gestation to rates observed at 25-26 weeks of gestation.
RESULTS
Discordant antenatal corticosteroid use and resuscitation, where one and not the other occurred, were more frequent for births at 22 and 23 but not 24 weeks (rate ratio [95% CI] at 22 weeks: 1.7 [1.3-2.2]; 23 weeks: 2.6 [2.2-3.2]; 24 weeks: 1.0 [0.8-1.2]) when compared with 25-26 weeks. Among infants resuscitated at 23 weeks, adjusting each hospital's rate of antenatal corticosteroid use to the average at 25-26 weeks (89.2%) was projected to increase infant survival by 7.1% (95% CI 5.4-8.8%) and survival without severe impairment by 6.4% (95% CI 4.7-8.1%). No significant change in outcomes was projected for infants resuscitated at 22 weeks, where few (n = 22) resuscitated infants received antenatal corticosteroids.
CONCLUSIONS
Infants born at 23 weeks were more frequently resuscitated without antenatal corticosteroids than other extremely preterm infants. When resuscitation is intended, consistent provision of antenatal corticosteroids may increase infant survival and survival without impairment.
TRIAL REGISTRATION
ClinicalTrials.govNCT00063063 (Generic Database) and NCT00009633 (Follow-Up Study).
目的
描述极早产儿产前皮质类固醇使用和复苏的不一致性及其与婴儿存活率和神经发育的关系。
研究设计
一项多中心队列研究，纳入了 2006 年至 2011 年期间在 24 家美国医院出生的 4858 名 22-26 周龄的婴儿，这些婴儿参加了 Eunice Kennedy Shriver 国家儿童健康与人类发育研究所新生儿研究网络。通过 2013 年的随访，4576 名（94.2%）婴儿在 18-22 个月时校正年龄时获得了生存和神经发育结果。我们描述了产前干预措施、复苏和婴儿结局。我们建立了模型，以评估每个医院将接受 22-24 周出生的需要复苏的婴儿的产前皮质类固醇暴露率提高至 25-26 周出生婴儿的水平，对婴儿结局的影响。
结果
与 25-26 周相比，在 22 周和 23 周出生的婴儿中，出现了未接受或接受了不一致的产前皮质类固醇使用和复苏的情况更为常见（22 周的比率比[95%可信区间]：1.7[1.3-2.2]；23 周：2.6[2.2-3.2]；24 周：1.0[0.8-1.2]）。在接受复苏的 23 周龄婴儿中，将每个医院的产前皮质类固醇使用率调整至 25-26 周龄的平均水平（89.2%），预计会使婴儿存活率提高 7.1%（95%可信区间 5.4-8.8%），无严重损伤的存活率提高 6.4%（95%可信区间 4.7-8.1%）。在接受复苏的 22 周龄婴儿中，预计不会出现明显的结局变化，因为很少（n=22）接受复苏的婴儿接受了产前皮质类固醇。
结论
与其他极早产儿相比，23 周龄出生的婴儿更常因未接受产前皮质类固醇而复苏。如果需要复苏，一致提供产前皮质类固醇可能会提高婴儿的存活率和无损伤存活率。
试验注册
ClinicalTrials.govNCT00063063（通用数据库）和 NCT00009633（随访研究）。
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