产前糖皮质激素疗程对早产儿并发症的影响

Effect of the completion of antenatal corticosteroid therapy on neonatal outcomes in preterm infants

目的探讨产前糖皮质激素疗程是否完成对胎龄<32周早产儿并发症的影响。方法选取2015年1月1日至2020年10月31日绍兴市妇幼保健院产科出生的胎龄<32周、出生2 h内转入新生儿科的早产儿636例作为研究对象,按照产前糖皮质激素疗程是否完成分为疗程完成组(产前糖皮质激素使用4次)和疗程未完成组(产前糖皮质激素使用1~3次)。采用单因素分析和多因素logisitc回归分析比较产前糖皮质激素疗程是否完成对早产儿严重脑室周围-脑室内出血(IVH)(Ⅲ~Ⅳ级)、Ⅱ期及以上新生儿坏死性小肠结肠炎(NEC)、支气管肺发育不良、脑室周围白质软化、早产儿视网膜病、死亡等主要并发症的影响情况。结果产前糖皮质激素疗程完成组354例(55.66%),未完成疗程组282例(44.34%)。单因素分析显示,疗程未完成组男孩比例、出生胎龄、出生体质量、母亲年龄≥35岁比例、剖宫产率、重度子痫前期发生率、距离分娩时胎膜早破时间≥18 h发生率、羊水过少发生率均低于疗程完成组(均P<0.05),而疗程未完成组胎盘早剥发生率、死亡率、严重IVH、NEC发生率均高于疗程完成组(均P<0.05)。矫正多种危险因素后,多因素logistic回归分析显示产前完成糖皮质激素疗程可明显降低死亡率和Ⅱ期及以上NEC发生率(均P<0.05)。结论产前完成糖皮质激素疗程可明显降低胎龄<32周早产儿死亡率和Ⅱ期及以上NEC发生率,减少严重并发症的发生。

Objective To explore the effect of the completion of antenatal corticosteroid(ACS)therapy on the neonatal outcomes in preterm infants.Methods A total of 636 preterm infants with gestational age(GA)<32 weeks,who were admitted to the NICU of Shaoxing Women and Children's Hospital within 2 h after birth from January 2015 to October 2020,were recruited in the study.There were 354 cases in whom the maternal ACS course was completed(4 doses,ACS completion group),and 282 cases in whom the maternal ACS course was not completed(1-3 doses,ACS uncompleted group).The baseline characteristics and the neonatal outcomes were compared between two groups,and the relationship between ACS course completion and neonatal outcomes was assessed by univariate and multivariate logistic regression analysis.Results In ACS uncompleted group,the infants were more likely to be boys,born with cesarean section,with maternal age≥35 years,severe preeclampsia,PPROM>18 h,oligohydramnios,lower GA and lower birth weight,compared to those in ACS completion group(all P<0.05).Compared with ACS completion group,the incidence of placental obruption the incidence of death,severe intraventricular-hemorrhage(IVH)and necrotizing enterocolitis(NEC)were significantly higher in ACS uncompleted group(all P<0.05).There were no significant differences in the incidence of BPD,PVL and ROP between two groups(all P>0.05).Multivariate logistic regression analysis revealed that completed ACS courses were associated with a lower rate of neonatal mortality rate and lower incidence rate of NEC(both P<0.05).Conclusion The study indicates that a completed maternal antenatal corticosteroid course can reduce the incidence of serious neonatal complications for preterm infants.