Antenatal glucocorticoid treatment and cystic periventricular leukomalacia in very premature infants
Antenatal glucocorticoid treatment and cystic periventricular leukomalacia in very premature infants
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DOI：
10.1056/nejm199910143411604
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发表时间：
1999-10-14
影响因子：
158.5
通讯作者：
Lacaze-Masmonteil, T
中科院分区：
文献类型：
--
作者：
Baud, O;Foix-L'Helias, L;Lacaze-Masmonteil, T
背景产前糖皮质激素治疗可降低早产儿几种并发症的发生率。方法对1993年1月至1996年12月在巴黎地区三个围产期中心出生的883名胎龄在24~31周的活产儿进行回顾性分析。361名婴儿的母亲在分娩前接受倍他米松治疗，165名婴儿的母亲在分娩前接受地塞米松治疗，357名婴儿的母亲没有接受糖皮质激素治疗。结果在母亲接受倍他米松治疗的婴儿中，囊性脑室周围白质软化的发生率为4.4%，母亲接受地塞米松治疗的婴儿中，囊性脑室周围白质软化的发生率为11.0%，母亲未接受糖皮质激素治疗的婴儿中，囊性脑室周围白质软化的发生率为8.4%。在调整了胎龄、分娩方式、有无绒毛膜羊膜炎、胎膜破裂到分娩之间的间隔时间延长(24小时)、先兆子痫和使用宫缩药物后，产前暴露于倍他米松与囊性脑室周围白质软化症的风险低于未接受糖皮质激素治疗(调整后的优势比为0.5；95%可信区间为0.2至0.9)或暴露于地塞米松(调整后的优势比为0.3；95%可信区间为0.1至0.7)。母亲接受地塞米松治疗的婴儿与母亲未接受糖皮质激素治疗的婴儿相比，调整后的优势比为1.5(95%可信区间为0.8~2.9)。结论在极早产儿中，产前暴露于倍他米松而非地塞米松可降低囊性脑室周围白质软化症的风险。(N Engl J Med 1999；341：1190-6)(C)1999年，马萨诸塞州医学会。
Background Antenatal glucocorticoid therapy decreases the incidence of several complications among very premature infants. However, its effect on the occurrence of cystic periventricular leukomalacia, a major cause of cerebral palsy, remains unknown.Methods We retrospectively analyzed a cohort of 883 live-born infants, with gestational ages ranging from 24 to 31 weeks, who were born between January 1993 and December 1996 at three perinatal centers in the Paris area. The mothers of 361 infants had received betamethasone before delivery, the mothers of 165 infants had received dexamethasone before delivery, and the mothers of 357 infants did not receive glucocorticoids. We compared the rates of cystic periventricular leukomalacia among the three groups of infants in bivariate and multivariate analyses after adjustment for confounding factors.Results The rate of cystic periventricular leukomalacia was 4.4 percent among the infants whose mothers had received betamethasone, 11.0 percent among the infants whose mothers had received dexamethasone, and 8.4 percent among the infants whose mothers had not received a glucocorticoid. After adjustment for gestational age, the mode of delivery, and the presence or absence of chorioamnionitis, prolonged interval between the rupture of membranes and delivery (>24 hours), preeclampsia, and the use of tocolytic drugs, antenatal exposure to betamethasone was associated with a lower risk of cystic periventricular leukomalacia than was either the absence of glucocorticoid therapy (adjusted odds ratio, 0.5; 95 percent confidence interval, 0.2 to 0.9) or exposure to dexamethasone (adjusted odds ratio, 0.3; 95 percent confidence interval, 0.1 to 0.7). The adjusted odds ratio for the group of infants whose mothers had received dexamethasone as compared with the group of infants whose mothers had not received a glucocorticoid was 1.5 (95 percent confidence interval, 0.8 to 2.9).Conclusions Antenatal exposure to betamethasone but not dexamethasone is associated with a decreased risk of cystic periventricular leukomalacia among very premature infants. (N Engl J Med 1999;341:1190-6.) (C)1999, Massachusetts Medical Society.