Exposure to any antenatal corticosteroids and outcomes in preterm infants by gestational age: prospective cohort study.
Exposure to any antenatal corticosteroids and outcomes in preterm infants by gestational age: prospective cohort study.
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DOI：
10.1136/bmj.j1039
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发表时间：
2017-03-28
期刊：
影响因子：
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通讯作者：
Carlo WA
中科院分区：
文献类型：
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作者：
Travers CP;Clark RH;Spitzer AR;Das A;Garite TJ;Carlo WA
目的确定产前暴露于任何皮质类固醇是否与目前推荐使用的每个胎龄的较低死亡率相关。设计前瞻性队列研究。美国Pediatrix医疗集团的300个参与新生儿重症监护病房。参与者117941名婴儿，胎龄23 0/7至34 6/7周，出生于2009年1月1日至2013年12月31日。暴露任何产前皮质类固醇。主要结果测量死亡或主要医院发病率，通过胎龄和产前皮质类固醇暴露进行分析，模型校正了出生体重，性别，分娩方式和多胎分娩。结果与未暴露的婴儿相比，产前暴露于皮质类固醇的婴儿（n=81 832）在每次妊娠29周或更短、31周和33-34周时出院前死亡率显著降低（校正比值比范围为0.32 - 0.55）。需要产前皮质类固醇治疗以防止出院前死亡的人数从妊娠23周和24周的6人增加到妊娠34周的798人。在妊娠期最低的产前暴露于皮质类固醇的婴儿中，无主要医院发病率的存活率较高。与所有妊娠期小于30周且大多数妊娠期为30周或以后出生的婴儿相比，产前暴露于皮质类固醇的婴儿的严重颅内出血或死亡、2期或以上坏死性小肠结肠炎或死亡以及早产儿严重视网膜病变或死亡的发生率较低。结论：在妊娠23 ~ 34周出生的婴儿中，产前暴露于皮质类固醇与未暴露于皮质类固醇相比，在大多数妊娠中与较低的死亡率和发病率相关。产前暴露于皮质类固醇对死亡率的效应量似乎在最低妊娠期出生的婴儿中更大。
Objective To determine whether exposure to any antenatal corticosteroids is associated with a lower rate of death at each gestational age at which administration is currently recommended. Design Prospective cohort study. Settings 300 participating neonatal intensive care units of the Pediatrix Medical Group in the United States. Participants 117 941 infants 23 0/7 to 34 6/7 weeks’ gestational age born between 1 January 2009 and 31 December 2013. Exposure Any antenatal corticosteroids. Main outcomes measures Death or major hospital morbidities analyzed by gestational age and exposure to antenatal corticosteroids with models adjusted for birth weight, sex, mode of delivery, and multiple births. Results Infants exposed to antenatal corticosteroids (n=81 832) had a significantly lower rate of death before discharge at each gestation 29 weeks or less, 31 weeks, and 33-34 weeks compared with infants without exposure (range of adjusted odds ratios 0.32 to 0.55). The number needed to treat with antenatal corticosteroids to prevent one death before discharge increased from six at 23 and 24 weeks’ gestation to 798 at 34 weeks’ gestation. The rate of survival without major hospital morbidity was higher among infants exposed to antenatal corticosteroids at the lowest gestations. Infants exposed to antenatal corticosteroids had lower rates of severe intracranial hemorrhage or death, necrotizing enterocolitis stage 2 or above or death, and severe retinopathy of prematurity or death compared with infants without exposure at all gestations less than 30 weeks and most gestations for infants born at 30 weeks’ gestation or later. Conclusion Among infants born from 23 to 34 weeks’ gestation, antenatal exposure to corticosteroids compared with no exposure was associated with lower mortality and morbidity at most gestations. The effect size of exposure to antenatal corticosteroids on mortality seems to be larger in infants born at the lowest gestations.