| Objective: To retrospectively analyze the impact of prenatal dexamethasone usage on the incidence of complications,treatment options,outcomes after discharge and long term prognosis and to provide some insights into prenatal usage of dexamethasone in preterm infants.Methods: A retrospective analysis was performed on the 289 hospitalized preterm infants born less than 24 hours and hospitalized for more than 7 days from the Neonatal Intensive Care Unit(NICU)in Yancheng Maternity and Child Health Care Hospital from Jan 1,2011 to Dec 31,2011.The preterm infants were divided into two groups according to the prenatal dexamethasone application: infants who were given the prenatal dexamethasone and complete the course of treatment were included in the intervention group;infants those not given were included in the control group.They were further divided into three subgroups according to Gestational Age(GA): gestational age of <30 weeks,gestational age of 30 ~ 33 +6 weeks,and gestational age of 30 ~ 33 +6 weeks.Prenatal dexamethasone was administered at 6 mg each dose every 12 hours for a total of two days within 7 days before childbirth.The following information was collected and compared for subsequent analysis: general data,prenatal factors,medical imaging stage of NRDS,medical treatments,and outcomes after discharge.Follow-up was performed on the surviving children and the following data were collected and compared: the score of Neonatal Behavioral Neurological Assessment(NBNA)for preterm infants at Corrected Gestational Age(CGA)40 weeks,the results of cranial Magnetic Resonance Imaging(c MRI)in preterm infants at CGA44~48w [Punctate White Matter Damage(PWMD),Diffuse White Matter Damage(DWMD),Periventricular Leukomalacia(PVL),Periventricular-Intraventricular Haemorrhages(PIVH-IVH),Cerebellum Hemorrhage(CH),Cerebral Infarction(CI)],the head circumference at CGA1 year,CGA2 years and CGA3 years of age,and the score of Gesell scale(including adaptive behavior,individual-social behavior,gross motor behavior,fine motor behavior,and language ability)at the score of Gesell scale at CGA1 year,CGA2 years,CGA3 years and CGA6 years of age;the incidence of lower respiratory tract infections and the number of re-hospitalization in children below CGA1 year of age.Results:1.The intervention group was compared with the control group:(1)Comparison of general data: there were 289 preterm infants in the two groups,including 128 in the intervention group and 161 in the control group.Such data as average gestational age,male to female ratio,birth weight,age of mothers,mode of delivery,intrauterine distress,test tube infants,premature rupture of fetal membranes,placental abruption,placenta previa,gestational diabetes mellitus,gestational hypertension and chorionic amnioticitis,twins or multiple births between the two groups were not significantly different(P>0.05).(2)Comparison of major complications: the incidence of Neonatalrespi Ratory Distress Syndrome(NRDS),Retinopathy Of Prematurity(ROP),Bronchial Pulmonary Dysplasia(BPD),Neonatal Necrotizing Enterocolitis(NEC)and intracranial hemorrhage in the neonates was lower in the intervention group,and the difference was statistically significant(P<0.05).The imaging grading of NDRS showed that the incidence of grade Ⅲ and Ⅳ NRDS in the intervention group was significantly lower,and the difference was significant(P<0.05).(3)Comparison of treatment: the utilization rate of Pulmonary Surfactant(PS),the repeated utilization rate of PS,the utilization rate of continuous positive airway pressure(CPAP)and the utilization rate of mechanical ventilation were significantly lower in the intervention group than the control group,and the difference was statistically significant(P<0.05).(4)Comparison of treatment outcomes and hospital days: the rate of cure and improvement in the intervention group was higher than the control group and the average hospital days were shorter than the control group,with the difference statistically significant(P<0.05).(5)Comparison of the follow-up results: There were 113 cases,95 cases,89 cases and 39 cases followed in the intervention group at CGA1,2,3 and 6 years respectively,while the number in the control group were 123,94,100 and 39 respectively.The incidence of PWMD + DWMD,PVL,PIVH-IVH,and the number of lower respiratory tract infection within CAG1 year was much lower than the control group.And the personal social behavior scores the age of CAG3 and 6 were lower as well.The old gross movement behavior and fine motor behavior score at CAG2,3 and 6 years were significantly higher than the control group,and the differences were all significantly different(P<0.05).The NBNA score,the incidence of CH and CI,head circumferences of infants at concordant CAG ages,the scores of adaptive behavior and language behavior,and the number of hospitalization were statistically not significant beween the two group(P>0.05).2.Comparison of different gestational ages between the intervention group and the control group:(1)general data comparison: the intervention group,including 31 cases with a gestational age of <30 weeks,53 cases with a gestational age of 30 ~ 33 +6 weeks,and 44 cases with a gestational age of 34 ~ 36 +6 weeks;the control group,including 39 cases with a gestational age of <30 weeks,66 cases with a gestational age of 30 ~ 33 +6 weeks,and 56 cases with a gestational age of 34 ~ 36 +6 weeks.Such data of the preterm infants of various gestational ages at admission as average gestational age,male to female ratio,birth weight,twins or multiple births,age of mothers,mode of delivery,intrauterine distress,test tube infants,premature rupture of fetal membranes,placental abruption,placenta previa,gestational diabetes mellitus,gestational hypertension and chorionic amnioticitis between the two groups were not significantly different(P>0.05).(2)Comparison of major complications: the incidence of NRDS,BPD,ROP,NEC and intracranial hemorrhage between cases with a gestational age of <30 weeks and 30~33+6 weeks in the intervention group was lower than in the control group,and the difference was significant(P<0.05).The imaging grading comparison of NDRS showed that the incidence of grade Ⅲ and grade ⅣNRDS in cases with a gestational age of <30 and 30~33+6 weeks was significantly lower than in the control group,and the difference was significant(P<0.05).There was no significant difference in survival and long term prognosis with gestational age of 34 ~ 36 +6 weeks between the two groups.(P>0.05).(3)Comparison of treatment: the PS utilization rate,the PS repeat rate,the CPAP utilization rate and the oxygenation time of cases with a gestational age of <30 weeks in the intervention group were significantly lower than in the control group,and the differences were significant(P<0.05).The PS utilization rate,the CPAP utilization rate and the oxygenation time of cases with a gestational age of 30~33+6 weeks in the intervention group were significantly lower than in the control group,and the differences were significant(P<0.05).The treatment for cases with a gestational age of 34 ~ 36 +6 weeks between the 2 groups was not significantly different(P>0.05).(4)Comparison of treatment outcomes and hospital stay: the improvement rate of treatment of cases with a gestational age of <30 and 30~33+6 weeks in the interventional group was higher than in the control group and the mean hospital stay was lower than that in the control group,with the difference being significant(P<0.05).The difference in cases with a gestational age of 34 ~ 36 +6 weeks between the 2 groups was not significant(P>0.05).(5)Comparison of the follow-up results: The number of infants followed up in the intervention group at CGA 1 year of age in the subgroups <30 weeks,30~33+6 weeks and 34~36+6 weeks were 24,47 and 42 respectively,while there were 22,48 and 53 follewed in the each subgroup of the control group respectively.The number follewed in the intervention group at CGA 2 years of age in the subgroups <30 weeks,30~33+6 weeks and 34~36+6 weeks were 18,43 and 34 respectively,while there were 17,36 and 41 follewed in the each subgroup of the control group respectively.And the number was 20,36,33 and 8,21,10 in the intervention group while that was 17,39,44 and 8,20,11 in the control group at CGA 3 and 6 years of age individually in each corresponding subgroup.Subgroup comparison showed that in the intervention subgroup <30 weeks the incidence of PWMD+DWMD,PVL and PIVH-IVH;the number of lower respiratory tract infection and the score of personal-social behavior at the age of CGA 3 and 6 years of age was significantly lower than the counterpart subgroup in the control group;while the gross motor behavior scores and the motor behavior scores at the age of CGA 1,CGA 2,CGA 3 and CGA 6 were all higher than that in the control group,which was of statistical significance(P<0.05).And in the subgroup 30~33+6 weeks the incidence of PWMD+DWMD,PVL and PIVH-IVH;the number of lower respiratory tract infection and the score of personal-social behavior at the age of CGA 3 and 6 years of age was significantly lower than the counterpart subgroup in the control group;while the gross motor behavior scores and the motor behavior scores at the age of CGA 1,CGA 2,CGA 3 and CGA 6 were all higher than that in the control group,which was of statistical significance(P< 0.05).The gross motor behavior score and the fine motor behavior score at the age of CGA 2,CGA 3 and CGA 6 in cases with a gestational age of 34~36+6 weeks were significantly higher than that in the control group;while the score of individual-social behavior at CGA 3 years and CGA 6 years in the intervention group were significantly lower than that in the control group,and the difference was significant(P<0.05).There was no difference in the NBNA score,the incidence of CH and CI,the head circumference,adaptive behavior and language score,incidence of rehospitalization within 1 year after birth in each of the subgestation age group in the two goups(P> 0.05).Conclusions:1.Prenatal dexamethasone effective usage can significantly reduce the incidences of NRDS,BPD,NEC and intracranial hemorrhage in younger premature children of gestational age < 34 weeks,reduce the incidence degree of NRDS,reduce the application of both PS and auxiliary ventilation,shorten the hospital stay,improve the cure and improvement rate,and have a protective effect on the brain injury of premature infants.2.Neonatal dexamethasone administration can reduce the incidence of lower respiratory tract infection in preterm baby with gestational age <34 weeks in the long term,and shows positive effects on their sporting ability,but seems to have a negative effect on their social behavior. |
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