产前地塞米松暴露对极低和超低体重早产儿生存结局及早期并发症的影响

doi:10.16150/j.1671-2870.2021.01.009

摘要/Abstract

摘要：

目的:探讨产前地塞米松暴露对极低和超低体重早产儿出生后生存结局及早期并发症的影响。方法:回顾性分析2012年1月1日至2020年7月31日在徐州医科大学附属连云港医院产科分娩的355例新生儿临床资料,新生儿为出生体重均≤1 500 g的适于胎龄儿,均直接转入本院新生儿科救治。新生儿分为超低体重早产儿（29例）和极低体重早产儿（326例）,根据其出生前孕妇是否正规使用过地塞米松,再分别分为暴露组和未暴露组,比较组间早产儿间的生存结局,进一步对其中存活的298例早产儿的一般资料、出生后早期并发症以及母亲孕期并发症情况进行单因素分析,并采用二元logistic回归模型进行多因素研究。结果:在326例极低体重早产儿（出生体重大于1 000 g且小于等于1 500 g）中,暴露组（215例）与未暴露组（111例）间的一般临床资料（性别、出生体重、胎龄、Apgar评分、胎数、分娩方式、住院时间、氧疗时间）比较,差异均无统计学意义（P>0.05）,暴露组的死亡率低于未暴露组（9例比41例,8.1%比19.1%）,差异有统计学意义（χ²=6.774,P=0.009）;2组间出生后早期并发症（新生儿黄疸、新生儿贫血、坏死性小肠结肠炎、新生儿肺炎、动脉导管未闭、脑室内出血）的发生率差异无统计学意义（P>0.05）。极低体重早产儿暴露组的呼吸窘迫综合征、支气管肺发育不良发生率均低于未暴露组（24.5%比37.9%、19.6%比31.0%）（P<0.05）,产前使用地塞米松是呼吸窘迫综合征的独立保护因素。极低体重早产儿暴露组的新生儿低血糖、新生儿败血症、早产儿视网膜病发生率高于未暴露组（P<0.05）,产前使用地塞米松是以上这些并发症发生的独立危险因素[比值比（odds ratio,OR）值分别为4.332、2.813、4.888,95%置信区间（confidence interval,CI）分别为2.443~7.681、1.316~6.014、1.609~14.849]。2组间母亲孕期的并发症发生差异无统计学意义（P>0.05）。在超低体重早产儿中,暴露组与未暴露组间的生存结局、一般资料、出生后早期并发症及母亲孕期并发症情况比较,差异均无统计学意义（P>0.05）。结论:产前使用地塞米松对超低体重早产儿的生存结局及早期并发症发生情况无影响,但可以降低极低体重早产儿的呼吸窘迫综合征、支气管肺发育不良发生率,提高生存率、改善预后,但同时会增加新生儿视网膜病、低血糖及败血症的发生率。

关键词: 地塞米松, 极低体重早产儿, 超低体重早产儿, 并发症

Abstract:

Objective: To explore the effect of prenatal exposure to dexamethasone on early postnatal complications and survival outcomes in the newborns with very low and extremely low birth weight. Methods: The information of 355 infants born in the Obstetrics Department of the Lianyungang Hospital Affiliated to Xuzhou Medical University from Ja-nuary 1, 2012 to July 31, 2020 was collected and used to do a retrospective analysis. The newborns were transferred directly to the Department of Neonatal in the same hospital because of birth weight ≤1 500 g. The infants with very low(birth weight greater than 1 000 g and less than 1 500 g) and extremely low birth weight(birth weight<1 000 g） were divi-ded into the exposed and unexposed groups according to whether their mothers received or did not receive standard dexamethasone therapy before giving birth, and the survival outcomes and incidence of early complications were compared between the two groups. Based on the general data of 298 living premature infants, a univariate analysis and binary logistic regression were performed to analyzethe risk factors of earlycomplications. Results: In 326 infants with very low birth weight,the mortality rate of the exposed group was lower than that of the unexposed group (8.1% vs. 19.1%) ( χ²=6.774, P=0.009). The clinical data between the exposed and unexposed groups including gender, birth weight, gestational age, Apgar score, fetal number, delivery method, hospital stay, oxygen therapy time didn′t show statistically different (P>0.05). In addition, the early postnatal complications including the incidence of jaundice, neonatal anemia, neonatal pneumonia, necrotizing enterocolitis, patent ductus arteriosus and intraventricular hemorrhage were similar between the exposed and unexposed groups (P>0.05). The incidences of RDS (respiratory distress syndrome) and broncho-pulmonary dysplasia in the exposed group were lower than those in the unexposed group (24.5% vs. 37.9%, 19.6% vs. 31.0%, P<0.05), and prenatal use of dexamethasone was a protective factor for occurrences of RDS. However, the incidences of neonatal hypoglycemia, neonatal sepsis, and retinopathy of prematurity in the exposed group were higher than those in the unexposed group (P<0.05) in the infants with very low weight. The prenatal use of dexamethasone was an independent risk factor for occurrences of early complications mentioned above (OR values were 4.332, 2.813, 4.888, and 95%CI were 2.443-7.681, 1.316-6.014, 1.609-14.849, respectively).There was no statistical difference in the perinatal complication of pregnant women between the exposed group and the unexposed group (P>0.05). For extremely low birth weight infant,there was no significant difference in survival outcomes, general neonatal information, early postnatal complications, and maternal complications between exposed and unexposed groups. Conclusions: Prenatal use of dexamethasone has no effect on survival outcomes and early complications in the infants with extremely low birth weight. It could improve survival rate and prognosis in the infants with very low birth weight by reducing the occurrences of postnatal RDS and broncho-pulmonary dysplasias, while it may increase the incidences of retinopathy of prematurity, neonatal hypoglycemia and neonatal sepsis in them.

Key words: Dexamethasone, Very low birth weight, Extremely low birth weight, Complication

中图分类号:

R722

申璐, 殷其改. 产前地塞米松暴露对极低和超低体重早产儿生存结局及早期并发症的影响[J]. 诊断学理论与实践, 2021, 20(01): 60-65.

SHEN Lu, YIN Qigai. Effects of prenatal exposure to dexamethasone on early complications and survival outcome in the newborns with very and extremely low birth weight[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(01): 60-65.

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参考文献 21

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结局	超低体重早产儿(n=29)		极低体重早产儿(n=326)
结局	暴露组 (n=12)	未暴露组 (n=17)	暴露组 (n=111)	未暴露组 (n=215)
存活	10	12	102(91.9%)	174(80.9%)
死亡	2	5	9(8.1%)	41(19.1%)
χ²值		-^a)		6.774
P值		0.665		0.009

项目	超低体重早产儿(n=22)				极低体重早产儿( n=276)
项目	暴露组(n=10)	未暴露组(n=12)	t或z或χ²值	P值	暴露组(n=102)	未暴露组(n=174)	t或z或χ²值	P值
住院时间(d)	66±26	48±19	t=-1.902	0.075	36(27~48)	38(29~47)	z=0.589	0.556
氧疗时间(d)	42±33	35±20	t=-0.598	0.559	6(3~19)	7(2~17)	z=-0.107	0.915
出生时体重(g)	900(763~968)	900(890~978)	z=-0.497	0.619	1 365±156	1 369±149	t=-0.210	0.834
出生时胎龄(周)	29(27~29)	29(28~29)	z=-0.100	0.920	31(29~32)	30(29~32)	z=-0.370	0.711
1 min Apgar评分（分）	6(4~8)	7(2~8)	z=-0.034	0.973	8(7~8)	8(7~8)	z=-0.642	0.521
5 min Apgar评分（分）	8(6~8)	8(4~8)	z=-0.137	0.891	9(8~9)	9(8~9)	z=-0.132	0.895
男性	5	3	-^a)	0.378	58	89	χ²=0.843	0.358
单胎	5	8	-^a)	0.666	79	136	χ²=0.019	0.891
剖宫产分娩	4	6	-^a)	0.691	57	79	χ²=2.826	0.093

并发症	超低体重早产儿^a)(n=22)		P值	极低体重早产儿(n=276)		χ²值	P值
并发症	暴露组(n=10)	未暴露组(n=12)	P值	暴露组(n=102)	未暴露组(n=174)	χ²值	P值
新生儿低血糖	3	2	0.624	49	32	27.261	<0.001
新生儿黄疸	6	6	0.691	47	82	0.028	0.866
新生儿贫血	10	9	0.221	49	93	0.753	0.385
新生儿肺炎	8	9	0.323	46	72	0.363	0.547
新生儿败血症	3	1	0.293	20	17	5.361	0.021
RDS	7	9	1.000	25	66	5.241	0.021
BPD	7	6	0.415	20	54	4.279	0.039
坏死性小肠结肠炎	1	0	0.455	9	8	1.987	0.159
动脉导管未闭	2	0	0.481	7	10	0.138	0.710
脑室内出血	2	3	1.000	12	23	0.123	0.726
ROP	3	0	0.078	11	6	5.987	0.014

并发症	超低体重早产儿^a)(n=22)		P值	极低体重早产儿(n=276)		χ²值	P值
并发症	暴露组(n=10)	未暴露组(n=12)	P值	暴露组(n=102)	未暴露组(n=174)	χ²值	P值
妊娠糖尿病	1	0	0.455	3	6	<0.001	1.000
妊娠高血压	4	6	0.691	36	49	1.535	0.215
前置胎盘	0	1	1.000	1	5	0.376	0.540
胎膜早破	2	0	0.195	22	45	0.645	0.422
胎盘早剥	0	1	1.000	3	11	1.526	0.217

影响因素	β	标准误差	Wald	OR值	95%CI	P值
影响因素	β	标准误差	Wald	OR值	下限~上限	P值
RDS	-0.680	0.337	4.075	0.507	0.262~0.980	0.044
BPD	-0.415	0.356	1.358	0.661	0.329~1.327	0.244
ROP	1.587	0.567	7.834	4.888	1.609~14.849	0.005
新生儿低血糖	1.466	0.292	25.176	4.332	2.443~7.681	<0.001
新生儿败血症	1.034	0.388	7.119	2.813	1.316~6.014	0.008