Terrone D A, Smith L G, Wolf E J, Uzbay L A, Sun S, Miller R C
Department of Obstetrics and Gynecology, Saint Barnabas Medical Center, Livingston, New Jersey 07039, USA.
Obstet Gynecol. 1997 Nov;90(5):819-23. doi: 10.1016/S0029-7844(97)00427-4.
To determine the effects of multiple courses of maternal betamethasone for fetal lung maturation on neonatal serum cortisol levels and clinical Cushing syndrome.
Seventy-nine mother-infant pairs delivered between 24 and 36 weeks' gestation were enrolled in the study. They were grouped according to the number of courses of betamethasone received between 24 and 34 weeks' gestation for fetal lung maturation: those receiving no courses, one course, and two or more courses. Physical examinations were performed and serum glucose, electrolyte, and cortisol levels were measured on days 1 and 3 of life.
For those receiving multiple courses of betamethasone (n = 43), the mean (+/- standard error of the mean [SEM]) number of courses was 5.3 +/- 0.4, with a mean (+/-SEM) total dose of 125.0 +/- 10.7 mg. No neonates had findings suggestive of Cushing syndrome. Day 1 cortisol levels (pooled mean +/- SEM) were 12.6 +/- 2.4, 5.3 +/- 3.2, and 4.4 +/- 1.8 microg/dL in those receiving no courses, one course, and two or more courses, respectively (P = .03; no courses versus two or more courses, P = .03), but the differences were not significant when corrected for multiple variables. Differences among day 3 cortisol levels (pooled mean +/- SEM) were not significant: 8.3 +/- 1.6, 5.8 +/- 1.4, and 5.8 +/- 0.9 microg/dL in those receiving no courses, one course, and two or more courses, respectively. None of the neonates in the group receiving no courses of betamethasone had day 1 cortisol levels lower than normal, whereas 22% and 11% of the neonates receiving one and two or more courses, respectively, had day 1 levels lower than normal. On day 3, 15% of those receiving one course and 10% of those receiving two or more courses had serum cortisol levels lower than normal, whereas none of those who received no courses had a low cortisol level. Multivariate regression analysis could show no association between the number of courses or total dose of betamethasone and the day 1 or day 3 cortisol values. The day 1 cortisol level (log10) was most associated with the severity of respiratory distress syndrome (RDS) and day 3 cortisol level (log10) with race and severity of RDS. Only in neonates with absent or mild RDS did number of courses correlate with day 3 cortisol levels (log10), but this was a positive correlation.
Serum cortisol levels either were independent of the number of courses or total dose of corticosteroids given or, in a subpopulation, were associated with increasing levels with increasing doses, suggesting that there is no suppressive effect with repeated dosing.
确定多次给予母体倍他米松促进胎儿肺成熟对新生儿血清皮质醇水平及临床库欣综合征的影响。
纳入79对孕24至36周分娩的母婴。根据孕24至34周期间为促进胎儿肺成熟接受倍他米松疗程的数量进行分组：未接受疗程组、接受1个疗程组、接受2个或更多疗程组。在出生第1天和第3天进行体格检查并测量血清葡萄糖、电解质及皮质醇水平。
对于接受多个疗程倍他米松的婴儿（n = 43），平均（±平均标准误[SEM]）疗程数为5.3±0.4，平均（±SEM）总剂量为125.0±10.7 mg。无新生儿有提示库欣综合征的表现。未接受疗程组、接受1个疗程组、接受2个或更多疗程组出生第1天的皮质醇水平（合并均值±SEM）分别为12.6±2.4、5.3±3.2和4.4±1.8 μg/dL（P = 0.03；未接受疗程组与接受2个或更多疗程组比较，P = 0.03），但校正多个变量后差异无统计学意义。出生第3天皮质醇水平（合并均值±SEM）在三组间差异无统计学意义：未接受疗程组、接受1个疗程组、接受2个或更多疗程组分别为8.3±1.6、5.8±1.4和5.8±0.9 μg/dL。未接受倍他米松疗程组的新生儿中，出生第1天皮质醇水平均不低于正常，而接受1个疗程组和接受2个或更多疗程组分别有22%和11%的新生儿出生第1天水平低于正常。出生第3天，接受1个疗程组的15%及接受2个或更多疗程组的10%血清皮质醇水平低于正常，而未接受疗程组无皮质醇水平低者。多因素回归分析未显示倍他米松疗程数或总剂量与出生第1天或第3天皮质醇值之间存在关联。出生第1天皮质醇水平（log10）与呼吸窘迫综合征（RDS）严重程度最相关，出生第3天皮质醇水平（log10）与种族及RDS严重程度相关。仅在无RDS或轻度RDS的新生儿中，疗程数与出生第3天皮质醇水平（log10）相关，但为正相关。
血清皮质醇水平要么与给予的皮质类固醇疗程数或总剂量无关，要么在亚组中与剂量增加呈水平升高相关，提示重复给药无抑制作用。
