Antenatal Corticosteroids and Outcomes in Preterm Twins
Antenatal Corticosteroids and Outcomes in Preterm Twins
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DOI：
10.1097/aog.0000000000003881
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发表时间：
2020-06-01
影响因子：
7.2
通讯作者：
Kikkawa, Fumitaka
中科院分区：
文献类型：
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作者：
Ushida, Takafumi;Kotani, Tomomi;Kikkawa, Fumitaka
目的：评估极早产儿和极早产儿产前皮质类固醇治疗对结局的改善是否与单胎相似，并研究产前皮质类固醇治疗是否根据绒毛膜性或出生顺序有不同的效果。方法：这项基于人群的研究基于日本新生儿研究网络收集的2003年至2015年出生时体重为1500 g或以下的新生儿数据分析，这些新生儿的胎龄为24 /7至31 /7周。在倾向评分匹配后，进行单变量逻辑分析和相互作用分析，比较产前接受糖皮质激素治疗的母亲的孩子与未接受糖皮质激素治疗的母亲的孩子的短期（新生儿期）和中期（3岁）结局。我们重点研究了单胎和双胞胎、单绒毛膜双胞胎和双绒毛膜双胞胎以及第一胎和第二胎之间的差异。结果：该研究包括23,502名单胎和6,546名双胞胎。在单胎和双胞胎中，产前皮质类固醇治疗与短期神经系统预后显著降低有关。然而，产前皮质类固醇治疗与单胎死亡率（比值比[OR] 0.61; 95% CI 0.53-0.70）、呼吸窘迫综合征（OR 0.71, 95% CI 0.67-0.76）和脑瘫（OR 0.85, 95% CI 0.72-0.99）显著降低相关，而与双胞胎无关（OR 0.89, 95% CI 0.68-1.17; OR 0.99, 95% CI 0.87-1.12; OR 0.82, 95% CI 0.61-1.11）。未发现绒毛膜性与产前皮质类固醇治疗对预后的影响之间存在关联。此外，除了心室周围白质软化症和坏死性小肠结肠炎（相互作用：P= 0.02和P= 0.04）外，出生顺序和产前皮质类固醇治疗对预后的影响没有关联。结论：双胞胎产前皮质类固醇治疗仅对短期神经系统预后有有益影响，对其他短期和中期预后没有改善。在时序性方面没有差异。
OBJECTIVE: To estimate whether improvement in outcomes from antenatal corticosteroid treatment in extremely and very preterm twins is similar to that observed in singletons, and to investigate whether antenatal corticosteroid treatment has different effects according to chorionicity or birth order. METHODS: This population-based study was based on an analysis of data collected by the Neonatal Research Network of Japan from 2003 to 2015 of neonates weighing 1,500 g or less at birth, from gestational ages of 24 0/7 to 31 6/7 weeks of gestation. After propensity score matching, univariate logistic and interaction analyses were performed to compare short-term (neonatal period) and medium-term (3 years of age) outcomes of the children of mothers who received antenatal corticosteroids with those of children of mothers who did not receive antenatal corticosteroids. We focused on differences between singletons and twins, between monochorionic and dichorionic twins and between the first and second twin. RESULTS: The study comprised 23,502 singletons and 6,546 twins. Antenatal corticosteroid treatment was associated with significant decreased short-term neurologic outcomes in both singletons and twins. However, antenatal corticosteroid treatment was associated with significantly decreased mortality (odds ratio [OR] 0.61; 95% CI 0.53-0.70), respiratory distress syndrome (OR 0.71, 95% CI 0.67-0.76), and cerebral palsy (OR 0.85, 95% CI 0.72-0.99) in singletons but not in twins (OR 0.89, 95% CI 0.68-1.17; OR 0.99, 95% CI 0.87-1.12; and OR 0.82, 95% CI 0.61-1.11, respectively). No association was found between chorionicity and the efficacy of antenatal corticosteroid treatment on outcomes. Further, no association was found between birth order and the efficacy of antenatal corticosteroid treatment on outcomes, except for periventricular leukomalacia and necrotizing enterocolitis (interaction:P=.02 andP=.04, respectively). CONCLUSION: Antenatal corticosteroid treatment in twins was associated with a beneficial effect on short-term neurologic outcomes only, without improvement in other short-term and medium-term outcomes. There was no difference related to chorionicity.