目的:确定产前皮质类固醇(ANS)暴露与主要发病率之间的剂量依赖性关联,以及极早产儿(EPI)或极低出生体重婴儿(ELBWI)在医院中的早期体重减轻百分比(EWLP)。
方法:多中心,我们对2017~2018年出生的EPI或ELBWI进行了回顾性队列研究.婴儿被归类为无ANS,部分ANS和完全ANS暴露组;三个亚组由胎龄和出生体重产生。进行多元logistic回归和多元线性回归。
结果:纳入了来自32个中心的725名婴儿。在没有ANS的情况下,部分ANS和完全ANS暴露,支气管肺发育不良(BPD)的比例存在显着差异(24.5%,25.4%和16.1%),坏死性小肠结肠炎(NEC)(6.7%,2.0%和2.0%)和死亡(29.6%,18.5%和13.5%),脑室内出血(IVH)的比例差异不明显(12.5%,13.2%和12.2%),和宫外生长受限(EUGR)(50.0%,56.6%和59.5%)。在逻辑回归中,与没有ANS暴露相比,完全ANS降低了BPD的风险(OR0.58,95%CI0.37至0.91),NEC(OR0.21,95%CI0.08至0.57)和死亡(OR0.36,95%CI0.23至0.56),和部分ANS降低了NEC(OR0.23,95%CI0.07至0.72)和死亡(OR0.54,95%CI0.34至0.87)的风险。与部分ANS暴露相比,完全ANS降低了BPD的风险(OR0.58,95%CI0.37至0.91)。ANS暴露与IVH之间无明显关联,EUGR。在多元线性回归中,部分和完全ANS暴露仅在≥28周(w)和<1000g亚组增加EWLP(p<0.05)。
结论:不同剂量的ANS(地塞米松)暴露与BPD有保护性相关,NEC,在医院死亡,但不是EPI或ELBWI出院时的EUGR。ANS(地塞米松)暴露与BPD之间存在有益的剂量依赖性关联。ANS暴露仅在≥28w和<1000g亚组中增加EWLP。ANS管理,尤其是完整的ANS,在早产前被鼓励。
背景:NCT06082414。
OBJECTIVE: To determine the dose-dependent associations between antenatal corticosteroids (ANS) exposure and the rates of major morbidities, and the early weight loss percentage (EWLP) in hospital among extremely preterm infants (EPI) or extremely low birthweight infants (ELBWI).
METHODS: A multicentre, retrospective cohort study of EPI or ELBWI born between 2017 and 2018 was conducted. Infants were classified into no ANS, partial ANS and complete ANS exposure group; three subgroups were generated by gestational age and birth weight. Multiple logistic regression and multiple linear regression were performed.
RESULTS: There were 725 infants included from 32 centres. Among no ANS, partial ANS and complete ANS exposure, there were significant differences in the proportions of bronchopulmonary dysplasia (BPD) (24.5%, 25.4% and 16.1%), necrotising enterocolitis (NEC) (6.7%, 2.0% and 2.0%) and death (29.6%, 18.5% and 13.5%), and insignificant differences in the proportions of intraventricular haemorrhage (IVH) (12.5%, 13.2% and 12.2%), and extrauterine growth restriction (EUGR) (50.0%, 56.6% and 59.5%). In the logistic regression, compared with no ANS exposure, complete ANS reduced the risk of BPD (OR 0.58, 95% CI 0.37 to 0.91), NEC (OR 0.21, 95% CI 0.08 to 0.57) and death (OR 0.36, 95% CI 0.23 to 0.56), and partial ANS reduced the risk of NEC (OR 0.23, 95% CI 0.07 to 0.72) and death (OR 0.54, 95% CI 0.34 to 0.87). Compared with partial ANS exposure, complete ANS decreased the risk of BPD (OR 0.58, 95% CI 0.37 to 0.91). There were insignificant associations between ANS exposure and IVH, EUGR. In the multiple linear regression, partial and complete ANS exposure increased EWLP only in the ≥28 weeks (w) and <1000 g subgroup (p<0.05).
CONCLUSIONS: Different doses of ANS (dexamethasone) exposure were protectively associated with BPD, NEC, death in hospital, but not EUGR at discharge among EPI or ELBWI. Beneficial dose-dependent associations between ANS (dexamethasone) exposure and BPD existed. ANS exposure increased EWLP only in the ≥28 w and<1000 g subgroup. ANS administration, especially complete ANS, is encouraged before preterm birth.
BACKGROUND: NCT06082414.