Long-term outcomes after repeat doses of antenatal corticosteroids
Long-term outcomes after repeat doses of antenatal corticosteroids
复制标题
DOI：
10.1056/nejmoa071453
复制
发表时间：
2007-09-20
影响因子：
158.5
通讯作者：
Gabbe, Steven G.
中科院分区：
文献类型：
--
作者：
Wapner, Ronald J.;Sorokin, Yoram;Gabbe, Steven G.
研究背景先前的研究表明，重复使用产前糖皮质激素可改善早产儿的某些新生儿结局，但会降低出生体重并增加胎儿宫内生长受限的风险。我们报道了在一项随机试验中登记的儿童的长期随访结果，比较了产前单疗程和重复疗程的皮质类固醇。方法妊娠23到31周的妇女在最初的皮质类固醇疗程后7天仍然怀孕，被随机分配到每周一疗程的倍他米松，包括12 mg肌肉注射，24小时重复一次，或看起来相同的安慰剂。我们研究了这些治疗后出生的儿童，他们的年龄在矫正后的2到3岁之间。结果总共有556名婴儿可供随访；486名儿童(87.4%)接受了体检，465名(83.6%)接受了Bayley测试，平均校正年龄(+/-SD)为29.3+/-4.6个月。在贝利结果或人体测量方面没有显著差异。重复使用糖皮质激素组有6名儿童(2.9%)出现脑性瘫痪，而安慰剂组有1名儿童(占妊娠0.5%)出现脑性瘫痪(相对危险度为5.7；95%可信区间为0.7~46.7；P=0.12)。尽管差异在统计学上并不显著，但在反复服用皮质类固醇的儿童中，脑性瘫痪的发生率更高，这一点值得关注，值得进一步研究。
BackgroundPrevious trials have shown that repeat courses of antenatal corticosteroids improve some neonatal outcomes in preterm infants but reduce birth weight and increase the risk of intrauterine growth restriction. We report long-term follow-up results of children enrolled in a randomized trial comparing single and repeat courses of antenatal corticosteroids.MethodsWomen at 23 through 31 weeks of gestation who remained pregnant 7 days after an initial course of corticosteroids were randomly assigned to weekly courses of betamethasone, consisting of 12 mg given intramuscularly and repeated once at 24 hours, or an identical-appearing placebo. We studied the children who were born after these treatments when they were between 2 and 3 years of corrected age. Prespecified outcomes included scores on the Bayley Scales of Infant Development, anthropometric measurements, and the presence of cerebral palsy.ResultsA total of 556 infants were available for follow-up; 486 children (87.4%) underwent physical examination and 465 (83.6%) underwent Bayley testing at a mean (+/-SD) corrected age of 29.3+/-4.6 months. There were no significant differences in Bayley results or anthropometric measurements. Six children (2.9% of pregnancies) in the repeat-corticosteroid group had cerebral palsy as compared with one child (0.5% of pregnancies) in the placebo group (relative risk, 5.7; 95% confidence interval, 0.7 to 46.7; P=0.12).ConclusionsChildren who had been exposed to repeat as compared with single courses of antenatal corticosteroids did not differ significantly in physical or neurocognitive measures. Although the difference was not statistically significant, the higher rate of cerebral palsy among children who had been exposed to repeat doses of corticosteroids is of concern and warrants further study.