Antenatal corticosteroids and the influence of sex on morbidity and mortality of preterm infants

To study the associated effect of a complete course of antenatal corticosteroids (ACSs) on mortality and morbidity rates among preterm infants in our population. Observational prospective study of infants born at less than 32 weeks’ gestation and admitted to our Neonatal Care Unit between January 2012 and December 2018. We analyzed mortality at discharge and respiratory and neurological morbidity, both during hospitalization and at 24 months’ postmenstrual age. The study included a total of 710 patients with a median gestational age of 28.5 weeks (IQR 26.4–30.5) and mean weight of 1.090 g (IQR 800–1.391). Of which, 62.4% received a complete course of antenatal steroids. Given the differences observed in the baseline characteristics of patients who either did or did not receive a full course of antenatal steroids, a propensity score covariate adjustment was performed for all estimations. The effect of ACS therapy differs depending on sex with a positive effect on acute respiratory morbidity and mortality in male patients of less than 29 weeks’ gestation. In female infants, there is no significant beneficial association between ACS therapy and mortality or any of the morbidities studied. In our population of preterm infants, treatment with antenatal steroids is associated with a different effect depending on sex. Antenatal steroids therapy associated with a positive effect in male patients with a gestational age of less than 29 weeks.

本研究旨在探讨完整疗程产前糖皮质激素（antenatal corticosteroids, ACSs）对本研究队列早产儿死亡率与并发症发生率的关联效应。本研究为前瞻性观察性研究，纳入2012年1月至2018年12月期间于本院新生儿护理单元（Neonatal Care Unit）收治的胎龄小于32周的早产儿。本研究分析了患儿出院时的死亡率，以及住院期间及矫正胎龄24个月时的呼吸系统与神经系统并发症发生情况。本研究共纳入710例患儿，其胎龄中位数为28.5周（四分位间距Interquartile Range, IQR：26.4~30.5周），出生体重均值为1.090 g（四分位间距IQR：800~1391 g）。其中62.4%的患儿接受了完整疗程的产前糖皮质激素治疗。鉴于接受与未接受完整产前糖皮质激素疗程的患儿基线特征存在显著差异，本研究对所有统计估计均采用倾向得分协变量校正方法。ACS治疗的效应存在性别差异：对于胎龄小于29周的男性患儿，该治疗可显著降低其急性呼吸系统并发症发生率与死亡率。而在女性患儿中，ACS治疗与死亡率或本研究关注的各类并发症均无显著有益关联。综上，在本研究的早产儿队列中，产前糖皮质激素治疗的效应存在性别差异；对于胎龄小于29周的男性患儿，该治疗具有显著的有益效应。