UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
Fetal Medicine Unit, University College London Hospital, London, UK.
Prenat Diagn. 2020 Jul;40(8):991-997. doi: 10.1002/pd.5727. Epub 2020 May 24.
In gastroschisis, there is evidence to suggest that gut dysfunction develops secondary to bowel inflammation; we aimed to evaluate the effect of maternal antenatal corticosteroids administered for obstetric reasons on time to full enteral feeds in a multicenter cohort study of gastroschisis infants.
A three center, retrospective cohort study (1992-2013) with linked fetal/neonatal gastroschisis data was conducted. The primary outcome measure was time to full enteral feeds (a surrogate measure for bowel function) and secondary outcome measure was length of hospital stay. Analysis included Mann-Whitney and Cox regression.
Of 500 patients included in the study, 69 (GA at birth 34 [25-38] weeks) received antenatal corticosteroids and 431 (GA at birth 37 [31-41] weeks) did not. Antenatal corticosteroids had no effect on the rate of reaching full feeds (Hazard ratio HR 1.0 [95% CI: 0.8-1.4]). However, complex gastroschisis (HR 0.3 [95% CI: 0.2-0.4]) was associated with an increased time to reach full feeds and later GA at birth (HR 1.1 per week increase in GA [95% CI: 1.1-1.2]) was associated with a decreased time to reach full feeds.
Maternal antenatal corticosteroids use, under current antenatal steroid protocols, in gastroschisis is not associated with an improvement in neonatal outcomes such as time to full enteral feeds or length of hospital stay.
在先天性脐膨出中，有证据表明肠道功能障碍是继发于肠道炎症；我们旨在通过对先天性脐膨出婴儿的多中心队列研究，评估因产科原因给予母体产前皮质类固醇对完全肠内喂养时间的影响。
进行了一项三中心回顾性队列研究（1992-2013 年），并对胎儿/新生儿先天性脐膨出数据进行了关联。主要结局指标是完全肠内喂养时间（肠道功能的替代指标），次要结局指标是住院时间。分析包括曼-惠特尼和 Cox 回归。
在纳入的 500 例患者中，69 例（出生时 GA 为 34 周[25-38 周]）接受了产前皮质类固醇治疗，431 例（出生时 GA 为 37 周[31-41 周]）未接受治疗。产前皮质类固醇对达到完全喂养的速度没有影响（风险比 HR 1.0[95%CI：0.8-1.4]）。然而，复杂的先天性脐膨出（HR 0.3[95%CI：0.2-0.4]）与达到完全喂养的时间延长有关，出生时 GA 增加（GA 每增加一周 HR 为 1.1[95%CI：1.1-1.2]）与达到完全喂养的时间缩短有关。
根据目前的产前类固醇方案，在先天性脐膨出中使用母体产前皮质类固醇并不能改善新生儿结局，如完全肠内喂养时间或住院时间。
