Pediatrics, Soonchunhyang University Hospital Seoul, Yongsan-gu, Korea.
Pediatrics, Soonchunhyang University College of Medicine, Cheonan, Korea (the Republic of).
BMJ Paediatr Open. 2023 Jan;7(1). doi: 10.1136/bmjpo-2022-001754.
To investigate whether effects of antenatal corticosteroids on neonatal outcomes in preterm infants with very low birth weight were different by plurality.
Nationwide prospective cohort study.
Twins and singletons with very low birth weight (<1500 g) who were born between 23 and 33 weeks of gestation and registered in the Korean Neonatal Network from January 2014 to December 2019.
Morbidity and mortality before discharge from neonatal intensive care unit.
Among a total of 9531 preterm infants with very low birth weight, there were 2364 (24.8%) twins and 7167 (75.2%) singletons. While 83.9% of singletons were exposed to at least one dose of antenatal corticosteroids, so were 87.9% of twins.Interaction analysis demonstrated that there was no significant difference in the effect of antenatal corticosteroids on morbidities or mortality between twins and singletons in either gestational age group (23-28 weeks or 29-33 weeks).Antenatal corticosteroids significantly decreased the risk of surfactant use (adjusted relative risk (aRR): 0.972 (95% CI: 0.961 to 0.984)), high-grade intraventricular haemorrhage (aRR: 0.621 (95% CI: 0.487 to 0.794)), periventricular leucomalacia (aRR: 0.728 (95% CI: 0.556 to 0.954)) and mortality (aRR: 0.758 (95% CI: 0.679 to 0.846)) in the gestational age group of 23-28 weeks. In the gestational age group of 29-33 weeks, antenatal corticosteroids significantly decreased the risk of surfactant use (aRR: 0.914 (95% CI: 0.862 to 0.970)) and mortality (aRR: 0.409 (95% CI: 0.269 to 0.624)) but increased the risk of sepsis (aRR: 1.416 (95% CI: 1.018 to 1.969)).
This study demonstrates that effect of antenatal corticosteroids on neonatal outcomes of preterm infants with very low birth weight does not differ significantly by plurality (twin or singleton pregnancy).
探讨产前皮质类固醇对极低出生体重早产儿新生儿结局的影响是否因多胎性而异。
全国性前瞻性队列研究。
2014 年 1 月至 2019 年 12 月在韩国新生儿网络注册的胎龄 23 至 33 周之间出生且出生体重极低（<1500g）的双胎和单胎儿。
新生儿重症监护病房出院前的发病率和死亡率。
在总共 9531 名极低出生体重早产儿中，有 2364 名（24.8%）是双胎儿，7167 名（75.2%）是单胎儿。虽然 83.9%的单胎儿接受了至少一剂产前皮质类固醇治疗，但双胎儿中也有 87.9%接受了治疗。交互分析表明，在胎龄组（23-28 周或 29-33 周）中，产前皮质类固醇对双胎儿和单胎儿的发病率或死亡率的影响均无显著差异。产前皮质类固醇可显著降低表面活性剂使用风险（调整后的相对风险（aRR）：0.972（95%CI：0.961-0.984））、高级别脑室内出血（aRR：0.621（95%CI：0.487-0.794））、脑室周围白质软化（aRR：0.728（95%CI：0.556-0.954））和死亡率（aRR：0.758（95%CI：0.679-0.846））在胎龄 23-28 周组。在胎龄 29-33 周组中，产前皮质类固醇可显著降低表面活性剂使用风险（aRR：0.914（95%CI：0.862-0.970））和死亡率（aRR：0.409（95%CI：0.269-0.624）），但增加了败血症风险（aRR：1.416（95%CI：1.018-1.969））。
本研究表明，产前皮质类固醇对极低出生体重早产儿新生儿结局的影响不因多胎性（双胎或单胎妊娠）而异。
