产前激素对晚期早产儿近期临床结局的影响

Effect of antenatal steroids on short-term clinical outcome in late-preterm infants

目的评价产前激素(antenatal steroid,AS)对晚期早产儿近期临床结局的影响。方法选取2020年1~12月于厦门市妇幼保健院分娩并收入新生儿重症监护室的胎龄34^(+0)~36^(+6)周的晚期早产儿作为研究对象,根据胎龄将其分为34^(+0)~34^(+6)周组、35^(+0)~35^(+6)周组、36^(+0)~36^(+6)周组,再根据其母亲产前是否使用激素治疗分为激素组和对照组,分析比较不同胎龄组间激素组和对照组患儿围产期的一般情况及近期的临床结局。结果研究共纳入490例早产儿,其中34^(+0)~34^(+6)周组116例(激素组104例,对照组12例),35^(+0)~35^(+6)周组189例(激素组134例,对照组55例),36^(+0)~36^(+6)周组185例(激素组114例,对照组71例)。晚期早产儿中AS使用率为71.8%(352/490),34^(+0)~34^(+6)周组AS使用率最高(P<0.001)。34^(+0)~34^(+6)周组中,激素组早产儿脑室内出血(intraventricular hemorrhage,IVH)的发生率显著低于对照组(P<0.05),不同胎龄分组中,激素组和对照组在机械通气、新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)、低血糖比例及住院时间方面比较差异均无统计学意义(P>0.05)。结论AS能够显著降低胎龄34^(+0)~34^(+6)周早产儿IVH的发生率,但对晚期早产儿的机械通气比例、住院时间及NRDS发生率无明显改善作用。

Objective To evaluate the effect of antenatal steroids(AS)on short–term clinical outcome in late–preterm infants.Methods The late–preterm infants with gestational age of 34^(+0)–36^(+6) weeks delivered in Xiamen Maternal and Child Health Hospital and admitted to neonatal intensive care unit from January to December 2020 were selected as the research subjects.According to gestational age,the infants were divided into 34^(+0)–34^(+6) weeks group,35^(+0)–35^(+6) weeks group and 36^(+0)–36^(+6) weeks group,and each group were further divided into hormone group and control group.The general perinatal characteristics and short–term clinical outcome between the two subgroups among the different gestational age were compared.Results A total of 490 cases were enrolled in the study,including 116 cases in 34^(+0)–34^(+6) weeks group(hormone group 104 cases,control group 12 cases),189 cases in 35^(+0)–35^(+6) weeks group(hormone group 134 cases,control group 55 cases),and 185 cases in 36^(+0)–36^(+6) weeks group(hormone group 114 cases,control group 71 cases).The rate of AS use in late–preterm infants was 71.8%(352/490).The rate of AS use was highest in 34^(+0)–34^(+6) weeks group(P<0.001).In 34^(+0)–34^(+6) weeks group,the incidence of intraventricular hemorrhage(IVH)in hormone group was significantly lower than that in control group(P<0.05).Among different gestational age groups,there were no significant differences in the use of mechanical ventilation,neonatal respiratory distress syndrome(NRDS),hypoglycemia and time of hospitalization between hormone group and control group(P>0.05).Conclusion AS can significantly reduce the incidence of IVH in preterm infants with gestational age of 34^(+0)–34^(+6) weeks,but has no significant improvement on the proportion of mechanical ventilation,time of hospitalization and incidence of NRDS in late–preterm infants.