孕母使用产前糖皮质激素对极早产儿结局及婴儿期神经发育的影响

Effects of antenatal corticosteroids on outcomes of very premature infants and neurodevelopment during infancy

摘要:

目的 探索孕母产前糖皮质激素（antenatal corticosteroid, ACS）的使用对极早产儿（very premature infant, VPI）结局及婴儿期神经发育的影响。方法 回顾性选取2020年1月—2022年12月安徽医科大学第一附属医院儿科收治的190例VPI为研究对象，按照孕母是否使用ACS及使用剂量分为未使用组（n=18）、单疗程组（n=88）、多疗程组（n=40）和部分疗程组（n=44）。比较4组VPI临床结局、矫正胎龄40周时新生儿神经行为评分、矫正年龄1岁时格塞尔发育量表评分的差异，分析特定胎龄VPI的ACS不同使用时机对矫正年龄1岁时婴幼儿格塞尔发育量表评分的影响。结果 临床结局方面，部分疗程组、单疗程组及多疗程组新生儿呼吸窘迫综合征、支气管肺发育不良、新生儿肺炎及新生儿湿肺的发生率低于未使用组（P<0.008），而部分疗程组、单疗程组及多疗程组间比较差异无统计学意义（P>0.008）。未使用组、部分疗程组、单疗程组矫正胎龄40周时新生儿神经行为评分（行为能力、主动肌张力、原始反射和一般评估）、矫正年龄1岁时神经发育正常比例高于多疗程组（P<0.008）。不同ACS使用时机对不同胎龄VPI矫正年龄1岁时神经发育无显著影响（P>0.05）。结论 ACS对VPI的呼吸系统发育具有重要价值，但多疗程ACS可能会造成VPI出现一定程度的神经发育异常，而对神经发育的影响与胎龄及ACS的使用时机无关。

Abstract:

Objective To explore the effects of antenatal corticosteroids (ACS) on the outcomes of very premature infants (VPIs) and neurodevelopment during infancy.Methods A retrospective study was conducted on 190 VPIs admitted to the Department of Pediatrics of the First Affiliated Hospital of Anhui Medical University from January 2020 to December 2022. The infants were categorized into four groups based on ACS usage and dosage: no ACS group (n=18), single-course group (n=88), multi-course group (n=40), and partial-course group (n=44). The clinical outcomes, Neonatal Behavioral and Neurological Assessment (NBNA) scores at 40 weeks of corrected age, and Gesell Developmental Schedule (Gesell) scores at 1 year of corrected age were compared among the four groups. The impact of timing of ACS use on the Gesell scores of infants at 1 year of corrected age in VPIs with specific gestational ages was analyzed.Results The incidence rates of neonatal respiratory distress syndrome, bronchopulmonary dysplasia, transient tachypnea of the newborn, and neonatal pneumonia were significantly lower in the partial-course, single-course, and multiple-course groups compared with the no ACS group (P<0.008). However, there was no significant difference among the partial-course, single-course, and multiple-course groups (P>0.008). The NBNA scores (behavioral ability, active muscle tone, primitive reflexes, and general assessment) at 40 weeks of corrected age were significantly higher in the no ACS, partial-course, and single-course groups than in the multiple-course group (P<0.008). The proportion of VPIs with normal neurodevelopment at 1 year of corrected age was significantly higher in the no ACS, partial-course, and single-course groups than in the multiple-course group (P<0.008). The timing of ACS use had no significant effect on neurodevelopment at a corrected age of 1 year in infants with various gestational ages (P>0.05).Conclusions ACS is crucial for the development of the respiratory system in VPIs, but multiple courses of ACS may cause neurodevelopmental abnormalities. The impact of ACS use on neurodevelopment is independent of gestational age and the timing of ACS use.