Department of Pediatrics, Jeonbuk National University School of Medicine, Jeonju, Korea.
Biomedical Research Institute of Jeonbuk National University Hospital, Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea.
PLoS One. 2020 Oct 5;15(10):e0240168. doi: 10.1371/journal.pone.0240168. eCollection 2020.
Antenatal corticosteroid (ACS) administration has been known as one of the most effective treatment in perinatal medicine, but the beneficial effects of ACS may vary not only gestational age, but also the quality of perinatal and neonatal care of the institution. This nationwide cohort study of the Korean Neonatal Network (KNN) data was consisted of <1,500g infants born at 23-34 weeks at 67 KNN hospitals between 2013 and 2017. The 9,142 eligible infants were assigned into two groups-group 1 and 2 <50% and ≥50% mortality rate, respectively, for 23-24 weeks' gestation-reflecting the quality of perinatal and neonatal care. Each group of infants were further stratified into 23-24, 25-26, 27-28, and 29-34 weeks of gestation age. Despite comparable ACS usage between group 1 (82%) and group 2 (81%), the benefits of ACS were only observed in group 1. In the multivariable analyses, infants of group 1 showed significant decrease in mortality and IVH at gestational age 23-24 weeks with ACS use, and the decrease was also seen in early-onset sepsis and respiratory distress syndrome at gestational age of 29-34 weeks while there were no significant decrease in group 2. In this study the overall data was congruent with the previous findings stating that ACS use decreases mortality and morbidity. These results indicate that the improved mortality of infants at 23-24 weeks' gestation reflects the quality improvement of perinatal and neonatal intensive care, which is a prerequisite to the benefits of ACS.
产前皮质类固醇（ACS）的应用已被公认为围产医学中最有效的治疗方法之一，但 ACS 的有益效果不仅因胎龄而异，还因机构的围产和新生儿护理质量而异。这项由韩国新生儿网络（KNN）数据进行的全国性队列研究包括 2013 年至 2017 年间在 67 家 KNN 医院出生的体重<1500g、胎龄为 23-34 周的婴儿。9142 名符合条件的婴儿被分为两组-第 1 组和第 2 组，其 23-24 周的胎龄死亡率分别为<50%和≥50%，反映了围产和新生儿护理的质量。每组婴儿进一步分为 23-24 周、25-26 周、27-28 周和 29-34 周的胎龄。尽管第 1 组（82%）和第 2 组（81%）的 ACS 使用情况相当，但 ACS 的益处仅在第 1 组中观察到。在多变量分析中，第 1 组的婴儿在使用 ACS 时，胎龄为 23-24 周的死亡率和 IVH 显著降低，在胎龄为 29-34 周时，早发性败血症和呼吸窘迫综合征的发病率也有所降低，而第 2 组则没有显著降低。在这项研究中，总体数据与之前的研究结果一致，即 ACS 的使用降低了死亡率和发病率。这些结果表明，23-24 周胎龄婴儿死亡率的提高反映了围产和新生儿重症监护质量的提高，这是 ACS 有益效果的前提。
