Antenatal corticosteroids in preterm small-for-gestational age infants: a systematic review and meta-analysis.
Antenatal corticosteroids in preterm small-for-gestational age infants: a systematic review and meta-analysis.
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DOI：
10.1016/j.ajogmf.2020.100215
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发表时间：
2020-11
影响因子：
6.3
通讯作者：
Tuuli MG
中科院分区：
文献类型：
--
作者：
Blankenship SA;Brown KE;Simon LE;Stout MJ;Tuuli MG
通过系统性综述和荟萃分析评估产前皮质类固醇（ACS）给药对早产小于胎龄（SGA）婴儿新生儿死亡率和发病率的影响。通过奥维德Medline、Embase、Scopus、科克伦系统性综述数据库（CDSR）、科克伦对照试验中心注册库、世界卫生组织国际临床试验注册门户网站和ClinicalTrials.gov进行了预定义的系统性检索，获得了1970-2019年的5，324篇文章。合格的研究比较了早产的SGA婴儿中接受ACS与未接受ACS的新生儿发病率和/或死亡率。主要结局为新生儿死亡率。次要结局为呼吸窘迫综合征（RDS）、坏死性小肠结肠炎（NEC）、脑室内出血和/或脑室周围白质软化（IVH和/或PVL）、支气管肺发育不良或早产儿慢性肺病（BPD或CLD）或新生儿败血症。我们通过Higgins I2和科克伦Q检验评估异质性，并使用随机效应模型计算合并优势比（OR）和95%置信区间（CI）。1995年至2018年发表的16项观察性队列和病例对照研究符合系统评价的选择标准，包括8，989名早产SGA婴儿。在8，376名SGA婴儿中明确报告了ACS管理; 4，631名（55.3%）接受ACS，3，741名（44.7%）未接受ACS。随后纳入了13项研究，包括6，387名早产SGA婴儿。接受ACS治疗的婴儿的新生儿死亡率显著低于未接受ACS治疗的婴儿（12项研究：12.8% vs. 15.1%，合并比值比[OR] 0.63 [95% CI 0.46-0.86]），研究间存在显著异质性（I2= 55.1%，p=0.011）。呼吸窘迫综合征无显著性差异（12项研究：OR 0.89 [95% CI 0.69-1.15]），NEC（7项研究：OR 0.93 [95% CI 0.70-1.22]），IVH和/或PVL（10项研究：OR 0.82 [95% CI 0.56-1.20]）、BPD或CLD（8项研究：OR 1.11 [95% CI 0.88-1.41]）或新生儿败血症（6项研究：OR 1.13 [95% CI 0.86-1.49]）。这些数据表明，ACS降低早产SGA婴儿的新生儿死亡率，对新生儿发病率无明显影响。这支持使用ACS来降低有早产风险的SGA婴儿的新生儿死亡率。产前皮质类固醇可降低早产SGA婴儿的新生儿死亡率，但对新生儿发病率无明显影响。
To estimate the effect of antenatal corticosteroid (ACS) administration on neonatal mortality and morbidity in preterm small-for-gestational age (SGA) infants through a systematic review and meta-analysis. A predefined, systematic search was conducted through Ovid Medline, Embase, Scopus, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trial Registry Portal, and ClinicalTrials.gov yielding 5,324 articles from 1970–2019. Eligible studies compared neonatal morbidity and/or mortality among SGA infants delivered preterm who received ACS to those who did not. The primary outcome was neonatal mortality. Secondary outcomes were respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), intraventricular hemorrhage and/or periventricular leukomalacia (IVH and/or PVL), bronchopulmonary dysplasia or chronic lung disease of prematurity (BPD or CLD), or neonatal sepsis. We assessed heterogeneity via Higgins I2 and Cochrane’s Q test, and calculated pooled odds ratios (OR) with 95% confidence intervals (CI) using random effects models. Sixteen observational cohort and case-control studies published from 1995–2018 met selection criteria for the systematic review and included 8,989 preterm SGA infants. ACS administration was explicitly reported among 8,376 SGA infants; 4,631 (55.3%) received ACS and 3,741 (44.7%) did not. Thirteen studies including 6,387 preterm SGA infants were then included in the meta-analysis. Neonatal mortality was significantly lower among infants who received ACS compared to those who did not (12 studies: 12.8% vs. 15.1%, pooled odds ratio [OR] 0.63 [95% CI 0.46–0.86]), with significant heterogeneity between studies (I2=55.1%, p=0.011). There was no significant difference in RDS (12 studies: OR 0.89 [95% CI 0.69–1.15]), NEC (7 studies: OR 0.93 [95% CI 0.70–1.22]), IVH and/or PVL (10 studies: OR 0.82 [95% CI 0.56–1.20]), BPD or CLD (8 studies: OR 1.11 [95% CI 0.88–1.41]), or neonatal sepsis (6 studies: OR 1.13 [95% CI 0.86–1.49]). These data show that ACS reduces neonatal mortality in SGA infants delivered preterm, with no apparent effect on neonatal morbidity. This supports the use of ACS to reduce neonatal mortality in pregnancies with SGA infants at risk for preterm birth. Antenatal corticosteroids reduce neonatal mortality in SGA infants delivered preterm, with no apparent effect on neonatal morbidity.
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影响因子：
7.2
作者：
Melamed, Nir;Pittini, Alex;Shah, Prakesh S.
通讯作者：
Shah, Prakesh S.
影响因子：
6.3
作者：
Downs, SH;Black, N
通讯作者：
Black, N
DOI：
10.1016/s0002-9378(16)33247-1
发表时间：
1977-01-01
影响因子：
9.8
作者：
GOULD, JB;GLUCK, L;KULOVICH, MV
通讯作者：
KULOVICH, MV
影响因子：
9.8
作者：
Gilbert, WM;Danielsen, B
通讯作者：
Danielsen, B
在一个医疗中心，早产小胎龄新生儿的产前皮质类固醇和结果。
影响因子：
--
作者：
Kim WJ;Han YS;Ko HS;Park IY;Shin JC;Wie JH
通讯作者：
Wie JH