Antenatal Corticosteroids and Outcomes of Small-for-Gestational-Age Neonates
Antenatal Corticosteroids and Outcomes of Small-for-Gestational-Age Neonates
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DOI：
10.1097/aog.0000000000001674
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发表时间：
2016-11-01
影响因子：
7.2
通讯作者：
Shah, Prakesh S.
中科院分区：
文献类型：
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作者：
Melamed, Nir;Pittini, Alex;Shah, Prakesh S.
目的：评估早产小胎龄（SGA）新生儿的产前皮质激素与新生儿结局的关联，并估计这种关联是否与适胎龄（AGA）新生儿的关联相似。方法：我们进行了一项回顾性队列研究，收集了2010年至2014年间在加拿大第三新生儿病房出生的妊娠24 /7周至33 /7周的单胎新生儿的数据。将产前1-7天接受糖皮质激素治疗的SGA新生儿（出生体重低于第10百分位）（n=698）与未接受糖皮质激素治疗的SGA新生儿（n=220）的结局进行比较。在出生前1-7天接受产前皮质类固醇治疗的AGA新生儿（出生体重在第10 - 90百分位之间）（n= 3781）和未接受产前皮质类固醇治疗的AGA新生儿（n= 1868）之间进行了类似的比较。使用多变量logistic回归评估产前皮质类固醇暴露与结局的关系，并比较SGA组和AGA组的调整优势比（ORs）。结果：在符合研究条件的6567名新生儿中，918名（14.0%）为SGA。在SGA组中，产前暴露于皮质类固醇的妇女与未暴露于皮质类固醇的妇女相比，新生儿死亡率较低（7%对12%，P= 0.01），而两组的综合转归率相似（28%对30%，P= 0.56）。在对潜在混杂因素进行校正后，在SGA组和AGA组中，产前1-7天暴露于皮质类固醇与新生儿死亡的几率相似（SGA：校正OR 0.29[95%置信区间（CI） 0.15-0.57]与AGA组相比：校正OR 0.40 [95% CI 0.29-0.54]， P= 0.40），综合结果(SGA：校正OR 0.53 [95% CI 0.33-0.87]与AGA组相比：调整OR 0.51 [95% CI 0.42-0.62]， P= 0.85)、机械通气需求（SGA：调整OR 0.60 [95% CI 0.39-0.91]，与AGA：调整OR 0.54 [95% CI 0.46-0.64]， P= 0.70）和重度脑损伤（SGA：调整OR 0.42 [95% CI 0.22-0.84]，与AGA：调整OR 0.39 [95% CI 0.30-0.51]， P= 0.80）。在出生体重小于胎龄和性别第5百分位的新生儿亚组中，观察到新生儿死亡的几率也有类似的降低：调整OR为0.38 （95% CI 0.16-0.92）。结论：对于SGA早产儿，出生前1-7天暴露于产前皮质类固醇与新生儿死亡率和发病率的降低有关，其程度与AGA新生儿相似。
OBJECTIVE: To assess the association of antenatal corticosteroids and neonatal outcomes of preterm small-for-gestational-age (SGA) neonates and estimate whether the association is similar to that observed in appropriate-for-gestational-age (AGA) neonates.METHODS: We conducted a retrospective cohort study using data collected on singleton neonates born between 24 0/7 and 33 6/7 weeks of gestation and admitted to tertiary neonatal units in Canada between 2010 and 2014. Outcomes of SGA neonates (birth weight less than the 10th percentile) who received antenatal corticosteroids 1-7 days before birth (n=698) were compared with those of SGA neonates who did not receive antenatal corticosteroids (n=220). A similar comparison was performed between AGA neonates (birth weight between 10th and 90th percentile) who received antenatal corticosteroids 1-7 days before birth (n=3,781) and AGA neonates that did not receive antenatal corticosteroids (n=1,868). The association of antenatal corticosteroid exposure with outcomes was assessed using multivariable logistic regression and adjusted odds ratios (ORs) were compared between SGA and AGA groups.RESULTS: Of the 6,567 neonates eligible for the study, 918 (14.0%) were SGA. Women in the SGA group who were exposed to antenatal corticosteroids had a lower rate of neonatal death (7% compared with 12%, P=.01) compared with those not exposed to antenatal corticosteroids, whereas the rate of composite outcome was similar between the two groups (28% compared with 30%, P=.56). After adjustment for potential confounders, exposure to antenatal corticosteroids 1-7 days before birth was associated with beneficial effects among both the SGA and AGA groups with similar reduced odds of neonatal death (SGA: adjusted OR 0.29 [95% confidence interval (CI) 0.15-0.57] compared with AGA: adjusted OR 0.40 [95% CI 0.29-0.54], P=.40), composite outcome (SGA: adjusted OR 0.53 [95% CI 0.33-0.87] compared with AGA: adjusted OR 0.51 [95% CI 0.42-0.62], P=.85), need for mechanical ventilation (SGA: adjusted OR 0.60 [95% CI 0.39-0.91] compared with AGA: adjusted OR 0.54 [95% CI 0.46-0.64], P=.70), and severe brain injury (SGA: adjusted OR 0.42 [95% CI 0.22-0.84] compared with AGA: adjusted OR 0.39 [95% CI 0.30-0.51], P=.80). Similar reduction in the odds of neonatal death was observed in the subgroup of neonates with birth weight less than the fifth percentile for gestational age and sex: adjusted OR 0.38 (95% CI 0.16-0.92).CONCLUSION: For SGA preterm neonates, exposure to antenatal corticosteroids 1-7 days before birth was associated with decreased odds of neonatal mortality and morbidity similar in magnitude to that observed among AGA neonates.