产前糖皮质激素治疗对早产儿听力筛查结果的影响  

Effect of prenatal glucocorticoid therapy on hearing screening in premature infants

作　　者：李莉[1] 魏璐 陈漳祯 潘凌昕 李禄全[2] 宋艳[2] LI Li;WEI Lu;CHEN Zhangzhen;PAN Lingxin;LI Luquan;SONG Yan(Department of Neonatology,Jiangxi Maternal and Child Health Hospital,Nanchang,330006,China;Department of Neonatology,Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics;Department of Children's Health,Jiangxi Maternal and Child Health Hospital)

机构地区：[1]江西省妇幼保健院新生儿科,南昌330006 [2]重庆医科大学附属儿童医院新生儿科国家儿童健康与疾病临床医学研究中心儿童发育疾病研究部重点实验室儿科学重庆市重点实验室 [3]江西省妇幼保健院儿童保健科

出　　处：《临床耳鼻咽喉头颈外科杂志》2024年第7期618-623,630,共7页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨产前糖皮质激素治疗对早产儿听力筛查的影响,为预防早产儿听力损伤提供科学依据。方法:回顾性分析2022年6月至2023年6月出生后24 h内在江西省妇幼保健院住院的693例胎龄24~34^(+6)周早产儿病例资料。根据产前是否使用地塞米松(dexamethasone,DXM)分为DXM组544例和非DXM组149例。对2组早产儿及产妇的一般资料进行比较,分析产前DXM不同剂量和不同给药时机对早产儿听力筛查结果的影响。结果:听力初筛方面,DXM组听力初筛通过率显著高于非DXM组(53.9%vs 35.6%),差异有统计学意义(P<0.05);进一步亚组分析,产前足量(=4剂)DXM组听力初筛通过率(58.1%)显著高于不足组(48.0%)和过量组(42.4%),差异有统计学意义(P<0.05);产前48 h~7 d给予DXM,听力初筛通过率高于产前<48 h或>7 d给予DXM(56.4%vs 48.6%),差异有统计学意义(P<0.05)。听力复筛方面,听力复筛通过率与产前DXM治疗无显著相关(P>0.05),但与患儿胎龄、出生体重、住院天数、是否使用有创机械通气及新生儿常见疾病(支气管肺发育不良、呼吸窘迫综合征)显著相关(P<0.05),其中支气管肺发育不良是听力复筛转诊的独立危险因素(P<0.05)。结论:孕妇产前48 h~7 d内单疗程足量DXM使用对其早产儿听力初筛结果显示出积极影响。Objective To explore the effect of prenatal glucocorticoids therapy on hearing screening in premature infants Methods Data of 693 preterm infants with gestational age of 24-34^(+6)weeks admitted to theJiangxi Maternal and Child Health Hospital within 24 h after birth from June 2022 to June 2023 were retrospectively analyzed.The infants were divided into the DXM group(544 cases)and the non-DXM group(149 cases)based on whether dexamethasone(DXM)was administered prenatally.General data of preterm infants and parturients in two groups were compared,and the effects of different doses and timing of DXM on hearing screening were analyzed.Results In the terms of preliminary hearing screening.the pass rate of initial hearing screening in DXM group was significantly higher than that in non-DXM group(53.9%vs 35.6%),with statistical significance(P<0.05).Further subgroup analysis showed that the passing rate of preliminary hearing screening in adequate prenatal dose(=4 doses)DXM group(58.1%)was significantly higher than that in insufficient group(48.0%)and excessive group(42.4%),with statistical significance(P<0.05).Administering DXM 48 hours to 7 days before birth resulted in a higher pass rate for initial hearing screening compared to administration<48 hours or>7 days before birth(56.4%vs.48.6%),with a statistically significant difference(P<0.05).In terms of re-hearing screening,the pass rate of secondary hearing screening was not significantly correlated with DXM treatment(P>0.05),but was significantly correlated with gestational age,birth weight,hospital stays,invasive mechanical ventilation,and common neonatal diseases(bronchopulmonary dysplasia,respiratory distress syndrome)(P<0.05).Among them,bronchopulmonary dysplasia was an independent risk factor forsecondary hearing screening referral(P<0.05).Conclusion A single course of adequate dexamethasone use within 48 h-7 d of prenatal has a positive effect on the preliminary hearing screening of preterm infants.

关 键 词：产前 糖皮质激素 听力筛查 早产儿 

分 类 号：R722.6[医药卫生—儿科]