Long-term outcomes of antenatal corticosteroids treatment in very preterm infants after chorioamnionitis
Long-term outcomes of antenatal corticosteroids treatment in very preterm infants after chorioamnionitis
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DOI：
10.1007/s00404-015-3762-6
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发表时间：
2015-12-01
影响因子：
2.6
通讯作者：
Fujimura, Masanori
中科院分区：
文献类型：
--
作者：
Miyazaki, Ken;Furuhashi, Madoka;Fujimura, Masanori
目的评价产前皮质类固醇（AC）治疗对极低出生体重早产儿组织学绒毛膜炎（HCA）后的短期和长期结局的影响。方法我们对2003年至2007年期间出生于22 + 0和33 + 6周的5240例单胎极低出生体重（VLBW）婴儿进行了回顾性分析，注册了日本新生儿研究网络。AC治疗对死亡率，神经发育的结果在3岁和新生儿发病率进行了分析，在组与无HCA使用Logistic回归analysis.Results在研究对象中，840与HCA，2734没有HCA，和1666被排除无HCA的数据。AC治疗与3岁以前死亡率降低显著相关; [0.52（0.32-0.86）]，[比值比（95%置信区间）]。两组在神经发育结局方面无差异，包括脑瘫[0.90（0.41-1.99）]，发育商< 70 [0.93（0.48-1.81）]、视力损害[0.46（0.04-5.18）]和重度听力损害[4.00（0.30-53.4）]。关于新生儿发病率，AC治疗与HCA组中呼吸窘迫综合征[0.67（0.50-0.91）]、脓毒症[0.62（0.41-0.94）]、迟发性肾上腺功能不全[0.62（0.39-0.98）]的发生率较低和慢性肺病[1.62（1.18-2.24）]的发生率增加相关。在无HCA组中，AC治疗与呼吸窘迫综合征减少相关[0.60（0.43-0.84）]和慢性肺病增加[1.34结论AC治疗可显著降低VLBW HCA患儿3岁以前的死亡率，但与神经发育结局无关。这与无HCA的婴儿的结果相同。AC疗法被推荐用于疑似绒毛膜炎的妇女，以及那些没有绒毛膜炎的妇女。
Purpose To evaluate the effect of antenatal corticosteroids (AC) therapy on short- and long-term outcomes among very low birth weight preterm infants after histologic chorioamnionitis (HCA).Methods We performed a retrospective analysis of 5240 single very low birth weight (VLBW) infants born at 22 + 0 and 33 + 6 weeks of gestation between 2003 and 2007, who registered to the Neonatal Research Network Japan. The effects of AC therapy on mortality, neurodevelopmental outcomes at 3 years of age and neonatal morbidities were analyzed in the groups with or without HCA using logistic regression analysis.Results In the study subjects, 840 were with HCA, 2734 were without HCA, and 1666 were excluded without data for HCA. AC therapy was significantly associated with decreasing mortality before 3 years of age; [0.52 (0.32-0.86)], [odds ratio (95 % confidence intervals]. There were no differences between the two groups regarding neurodevelopmental outcomes, including cerebral palsy [0.90 (0.41-1.99)], development quotient < 70 [0.93 (0.48-1.81)], visual impairment [0.46 (0.04-5.18)], and severe hearing impairment [4.00 (0.30-53.4)] in the group with HCA as well as without HCA. Regarding neonatal morbidities, AC therapy was associated with a lower incidence of respiratory distress syndrome [0.67 (0.50-0.91)], sepsis [0.62 (0.41-0.94)], late-onset adrenal insufficiency [0.62 (0.39-0.98)] and an increased incidence of chronic lung disease [1.62 (1.18-2.24)] in the group with HCA. In the group without HCA, AC therapy was associated with decreasing respiratory distress syndrome [0.60 (0.43-0.84)] and increasing chronic lung disease [1.34 (1.11-1.62)].Conclusion AC therapy is significantly associated with reduced mortality before 3 years of age in VLBW infants with HCA, but not with neurodevelopmental outcomes, which was same as the results found in infants without HCA. AC therapy is recommended for women with suspected chorioamnionitis, as well as those without chorioamnionitis.