目的:产前皮质类固醇(ACS)对于有早产风险的妇女是一种完善的治疗方法,可以改善新生儿结局。然而,关于ACS对后代发育中的大脑的潜在长期不利影响,已经提出了一些担忧。在这里,我们调查了足月等效年龄早产儿的ACS与皮质下节段体积之间的关联。
方法:这项回顾性观察研究使用2014-2020年在名古屋大学医院出生的220/7至336/7孕周早产单胎婴儿的临床数据进行。双侧丘脑的皮质下体积,尾状核,putamens,榆树,海马,杏仁核,使用自动分割工具评估伏隔核,婴儿自由冲浪,通过多元线性回归分析(协变量:磁共振成像月经后年龄,婴儿性,和出生时的胎龄)。我们比较了按出生时胎龄分层的每个皮质下体积(<28与≥28孕周)。
结果:多变量分析显示双侧杏仁核的体积明显较小(左,p<0.03;右,p<0.03)和尾状核(左,p<0.03;右,p=0.04)在ACS新生儿中。仅在妊娠28周或更晚出生的新生儿中观察到这些区域的体积明显较小。
结论:ACS与足月等效年龄的双侧杏仁核和尾状核体积较小有关。这种关联仅在妊娠28周或更晚出生的婴儿中观察到。
OBJECTIVE: Antenatal corticosteroids (ACS) is a well-established treatment for women at risk of preterm birth that improves neonatal outcomes. However, several concerns have been raised regarding the potential long-term adverse effects of ACS on the offspring\'s developing brain. Here we investigated the association between ACS and subcortical segmental volumes in preterm infants at term-equivalent age.
METHODS: This retrospective observational
study was conducted using the clinical data of preterm singleton infants born between 220/7 and 336/7 gestational weeks at Nagoya University Hospital in 2014-2020. Subcortical volumes of the bilateral thalami, caudate nuclei, putamens, pallidums, hippocampi, amygdalae, and nuclei accumbens were evaluated using an automated segmentation tool, Infant FreeSurfer, and compared between neonates exposed to a single course of ACS (n = 46) and those who were not (n = 13) by multiple linear regression analysis (covariates: postmenstrual age at magnetic resonance imaging, infant sex, and gestational age at birth). We compared each subcortical volume stratified by gestational age at birth (<28 vs. ≥28 gestational weeks).
RESULTS: Multivariate analyses revealed significantly smaller volumes in the bilateral amygdalae (left, p < 0.03; right, p < 0.03) and caudate nuclei (left, p < 0.03; right, p = 0.04) in neonates with ACS. Significantly smaller volumes in these regions were observed only in neonates born at 28 weeks of gestation or later.
CONCLUSIONS: ACS was associated with smaller volumes of the bilateral amygdalae and caudate nuclei at term-equivalent age. This association was observed exclusively in infants born at 28 weeks of gestation or later.