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JAMA:孕妇注射类固醇可提升早产儿存活率

2011/12/09 来源:新华网
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美国研究者发现,母亲出现早产迹象后注射类固醇类药物可大大提高早产儿的存活概率。

美国研究者发现,母亲出现早产迹象后注射类固醇类药物可大大提高早产儿的存活概率。

定于12月7日出刊的《美国医学会杂志》提前披露这一研究结果。研究发现,孕妇注射类固醇对早产儿肺功能和其他组织发育产生的推动作用快于预期,这意味着一旦母亲出现早产迹象,类固醇或可增加婴儿的存活率。

不过,类固醇对不同时期的早产儿产生效果不同。美国亚拉巴马大学伯明翰分校研究者瓦尔德马·卡罗及其同事在这篇文章中公开了对不同时期早产儿的比对研究结果。

对于22周以及不足22周早产儿而言,母亲是否使用类固醇差异不明显。

对于23周早产儿而言,如果母亲不使用类固醇,婴儿出生死亡以及婴儿出生8个月至22个月脑部发育出现问题的几率为90%;如果母亲使用类固醇,这一比率降至83%。

对于24周至34周的早产儿而言,如果母亲不使用类固醇,婴儿出生死亡以及婴儿出生18个月至22个月脑部发育出现问题的几率为80.3%;如果母亲使用类固醇,这一比率降至68%。

卡罗说,这项研究表明,类固醇对提高24周至34周早产儿的存活率有明显效果,但同样可用于提升23周早产儿的存活率。更重要的是,“我们同时发现,使用类固醇不会增加母亲的感染率”。

先前一些研究者认为,类固醇可能增加孕妇感染几率。另外,学界对注射类固醇的剂量和时机也存在争议。

不过,卡罗承认仍需更多试验和例证才能将这一研究结果应用于临床,因为现阶段研究仅关注存活率和脑部发育状况,对于类固醇“催熟”的早产儿在今后发育过程中是否会出现脑部以外疾病仍需更多跟进研究。


Association of Antenatal Corticosteroids With Mortality and Neurodevelopmental Outcomes Among Infants Born at 22 to 25 Weeks' Gestation

Waldemar A. Carlo, Scott A. McDonald, Avroy A. Fanaroff, Betty R. Vohr, Barbara J. Stoll, Richard A. Ehrenkranz,  William W. Andrews, PhD, Dennis Wallace, PhD; Abhik Das,  Edward F. Bell, Michele C. Walsh,MS; Abbot R. Laptook, Seetha Shankaran, Brenda B. Poindexter, MS; Ellen C. Hale,  Nancy S. Newman, Alexis S. Davis, Kurt Schibler, Kathleen A. Kennedy,  Pablo J. Sánchez,  Krisa P. Van Meurs, 

Context Current guidelines, initially published in 1995, recommend antenatal corticosteroids for mothers with preterm labor from 24 to 34 weeks' gestational age, but not before 24 weeks due to lack of data. However, many infants born before 24 weeks' gestation are provided intensive care.

Objective To determine if use of antenatal corticosteroids is associated with improvement in major outcomes for infants born at 22 and 23 weeks' gestation.

Design, Setting, and Participants Cohort study of data collected prospectively on inborn infants with a birth weight between 401 g and 1000 g (N = 10 541) born at 22 to 25 weeks' gestation between January 1, 1993, and December 31, 2009, at 23 academic perinatal centers in the United States. Certified examiners unaware of exposure to antenatal corticosteroids performed follow-up examinations on 4924 (86.5%) of the infants born between 1993 and 2008 who survived to 18 to 22 months. Logistic regression models generated adjusted odds ratios (AORs), controlling for maternal and neonatal variables.

Main Outcome Measures Mortality and neurodevelopmental impairment at 18 to 22 months' corrected age.

Results Death or neurodevelopmental impairment at 18 to 22 months was significantly lower for infants who had been exposed to antenatal corticosteroids and were born at 23 weeks' gestation (83.4% with exposure to antenatal corticosteroids vs 90.5% without exposure; AOR, 0.58 [95% CI, 0.42-0.80]), at 24 weeks' gestation (68.4% with exposure to antenatal corticosteroids vs 80.3% without exposure; AOR, 0.62 [95% CI, 0.49-0.78]), and at 25 weeks' gestation (52.7% with exposure to antenatal corticosteroids vs 67.9% without exposure; AOR, 0.61 [95% CI, 0.50-0.74]) but not in those infants born at 22 weeks' gestation (90.2% with exposure to antenatal corticosteroids vs 93.1% without exposure; AOR, 0.80 [95% CI, 0.29-2.21]). If the mothers had received antenatal corticosteroids, the following events occurred significantly less in infants born at 23, 24, and 25 weeks' gestation: death by 18 to 22 months; hospital death; death, intraventricular hemorrhage, or periventricular leukomalacia; and death or necrotizing enterocolitis. For infants born at 22 weeks' gestation, the only outcome that occurred significantly less was death or necrotizing enterocolitis (73.5% with exposure to antenatal corticosteroids vs 84.5% without exposure; AOR, 0.54 [95% CI, 0.30-0.97]).

Conclusion Among infants born at 23 to 25 weeks' gestation, antenatal exposure to corticosteroids compared with nonexposure was associated with a lower rate of death or neurodevelopmental impairment at 18 to 22 months.

文献链接http://jama.ama-assn.org/content/306/21/2348.short

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