Effect Of Antenatal Corticosteroids On The Neuropsychological And Behavioral Development In Moderate-late Preterm Infants

Objective To analyze the effects of antenatal corticosteroids（ACS）on neuropsychological behavior development of moderate-late preterm infants,retrospective study was performed,in order to provide clinical reference for ACS in moderate-late preterm infants.Methods Moderate-late preterm infants(32-36⁺⁶w)who were followed up in the high-risk outpatient department of from April 2018 to December 2020 were selected as the research subjects.According to the using of antenatal dexamethasone,they were divided into ACS group and non-ACS group.The ACS group was divided into single-course group and multi-course group according to the treatment course.According to different gestational age,the subjects were divided into two groups:moderate preterm group and late preterm group.According to the number of single delivery of infants were divided into singleton group and twin group.The research object of general information collection,early diagnosis and treatment of disease,the object of study on documentation and implementation of project management and collect follow-up ending,ending correction including 18 to 24 months of height,weight and head circumference and the development of the neuropsychological behavior in children aged 0 to 6 examination results,including the gross motor behavior,fine motor behavior,adaptability,language and social behavior separately,five in age mental and comprehensive age mental,actual months total developmental quotient,correct months total development.Results A total of 109 cases of premature infants met the inclusion criteria.The results were as following:（1）74 cases were in the ACS group,35 cases were in the non-ACS group,and the application rate of ACS at 32-34⁺⁶weeks was 77.4%.The average gestational age and birth weight of preterm infants in the ACS group were lower than those in the non-ACS group（P<0.05）,the use of assisted reproduction,the proportion of twins and the proportion of cesarean section of preterm infants in the ACS group were higher than those in the non-ACS group（P<0.05）,and the incidence of gestational diabetes mellitus in preterm infants in the ACS group was lower than that in the non-ACS group（P<0.05）.There were no significant differences in gender,Apgar≤7,maternal age,paternal age,premature rupture of membranes,gestational diabetes mellitus,gestational hypertension,chorionicamniotis,intrauterine infection,maternal thyroid dysfunction and HELLP syndrome between the two groups（P<0.05）.A total of 30 cases of moderate premature infants(32-33⁺⁶we)were diagnosed,including 25 cases in the ACS group and 5cases in the non-ACS group.Comparison between groups showed that the proportion of cesarean section of premature infants in ACS group was higher than that in the non-ACS group（P<0.05）.In late preterm(34-36⁺⁶w)group,a total of 79 cases,with ACS group 49cases,the non-ACS group 30 cases.Comparison results between groups showed that the average gestational age and birth weight in ACS group was less than the ACS group（P<0.05）,the ACS group premature in assisted reproduction,the proportion of twins were higher than in the ACS group（P<0.05）,the ACS group,the incidence rate of premature motherhood gestational diabetes is lower than the ACS group（P<0.05）.（2）the ACS group with premature early disease and ventilation treatment,according to the results of the comparison between groups showed that ACS group’s premature hospital stays longer comparing with the non-ACS group（P<0.05）,while in the incidence of NRDS,IVH,NEC,EOS and hypoglycemia and assisted ventilation treatment ratio,differences between the two groups have no statistical difference（P>0.05）,the groups comparing the difference between the disease diagnosis and ventilation treatment of no statistical significance（P>0.05）.In the late preterm group,according to the comparison results between the days of stay in the ACS group was longer than that in the non-ACS group（P<0.05）,and there was no statistically significant difference in disease diagnosis and ventilation treatment between the two groups（P>0.05）.（3）The follow-up results of the ACS group and the non-ACS group at corrected age of 18-24 months showed that the body length,body weight and head circumference of the subjects were all in the 25th-75th percentile of the corrected age physical development curve,but the mean values of the 3items were slightly lower than the 50th percentile,and the physical development difference between the two groups was not statistically significant.The overall neuropsychological behavior development level is lower than that of children at the same age,in which the gross motor level is the same as that of children of the same age,the adaptive ability level is about 1 month behind,the fine motor and language level is about 2 months behind,and the social behavior level is 3 months behind that of children of the same age,and the lag degree is the most obvious part.The mean values of corrected gross development quotient and actual gross development quotient of monthly age were both in the middle level,but lower than the normal level of children of the same age,and there was no statistical significance between each group.Among them,2 cases with mental retardation were in the single-course ACS group,11 were in the low critical group,10 were in the single-course ACS group,and 1 was in the non-ACS group.There was no significant difference in follow-up results in the singleton group,and between the ACS single-course group and multi-course group（P>0.05）.The social behavior of premature infants in the twin ACS group was lower than that in the non-ACS group（P<0.05）.（4）There was no correlation between the corrected development quotient and the age of application of single-course of ACS（r=0.118 P=0.365）.After controlling the gestational age variables,the two variables were analyzed by partial correlation（r=0.125 P=0.341）.There was no correlation between the duration of ACS treatment and the total development quotient of corrected months（r=0.118 P=0.365）.Conclusion The application of ACS has no effect on the incidence of early diseases in moderate-late preterm infants,including NRDS,IVH,NEC,EOS and hypoglycemia.The mean value of total development quotient at month of correction for moderate-late preterm infants was lower than that for healthy term birth children at the same age.Single or multiple courses of ACS had no effect on the neuropsychological behavior development of moderate-late preterm infants at 18 to 24 months of correction.The corrected total development quotient of moderate-late preterm infants at 18 to 24 months was not correlated with gestational age of single-course ACS.