Effect of prenatal glucocorticoid therapy on hearing screening in premature infants
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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。Abstract: 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+6weeks 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.
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Key words:
- prenatal /
- glucocorticoid /
- hearing screening /
- premature infants
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表 1 2组患儿一般资料比较
项目 DXM组(n=544) 非DXM组(n=149) χ2/t P 性别(男/女)/例 295/249 80/69 0.014 0.907 胎龄/周 33.1(31.7，34.1) 33(30.1，34.1) -1.116 0.265 出生体重/g 1 880(1 540，2 150) 1 780(1 393，2 100) -1.528 0.127 5 min Apgar评分 9.4±0.8 9.3±0.8 1.637 0.102 顺产/例(%) 121(22.2) 28(18.8) 0.825 0.364 试管婴儿/例(%) 121(22.2) 32(21.5) 0.040 0.842 多胎妊娠(单/双/3胎)/例 339/201/4 97/50/2 1.013 0.603 宫内窘迫/例(%) 114(20.9) 27(18.1) 0.580 0.446 母亲年龄/岁 30.5±4.6 30.2±5.1 0.740 0.460 产妇诊断绒毛膜羊膜炎/例(%) 106(19.5) 32(21.5) 0.615 0.418 产前使用硫酸镁/例(%) 112(20.6) 29(19.5) 0.624 0.432 胎盘早剥/例(%) 23(4.2) 7(4.7) 0.062 0.803 胎盘早破/例(%) 183(33.6) 45(30.2) 0.626 0.429 胎盘置入/例(%) 9(1.7) 4(2.6) 0.674 0.412 前置胎盘/例(%) 31(5.7) 7(4.7) 0.226 0.635 妊娠糖尿病/例(%) 92(16.9) 28(18.9) 0.289 0.591 妊娠高血压综合征/例(%) 72(13.2) 17(11.4) 0.348 0.555 妊娠甲状腺功能减退/例(%) 22(4.0) 4(2.6) 0.599 0.439 新生儿支气管肺发育不良/例(%) 28(5.1) 13(8.7) 2.690 0.101 新生儿呼吸窘迫综合征/例(%) 242(44.5) 75(50.3) 1.613 0.204 新生儿高胆红素血症/例(%) 396(72.8) 98(65.8) 2.818 0.093 新生儿败血症/例(%) 27(4.9) 11(7.4) 1.321 0.250 是否使用有创机械通气/例(%) 61(11.2) 21(14.2) 0.986 0.321 新生儿颅内出血/例(%) 87(16.4) 23(15.6) 0.046 0.830 住院天数/d 22.6±20.6 23.9±21.1 -0.701 0.483 
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表 2 DXM组与非DXM组早产儿听力初筛结果比较
组别 例数 听力初筛TEOAE/例(%) χ2 P 通过 转诊 产前是否使用DXM 15.651 ＜0.001 DXM组 544 293(53.9) 251(46.1) 非DXM组 149 53(35.6) 96(64.4) 产前DXM不同使用剂量 6.611 0.037 不足 179 86(48.0) 93(52.0) 3.631 0.057 足量 332 193(58.1) 139(41.9) 6.257 0.012 过量 33 14(42.4) 19(57.6) 1.849 0.174 产前DXM不同给药时机 48.204 ＜0.001 最优给药时机 367 207(56.4) 160(43.6) 次优给药时机 177 86(48.6) 91(51.4)
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表 3 早产儿复筛转诊的单因素分析
组别 TEOAE+AABR听力复筛 χ2/t P 通过(n=93) 转诊(n=24) 使用DXM/例(%) 67(72.0) 18(75.0) 0.084 0.772 性别(男/女)/例 56/37 19/5 2.978 0.084 胎龄/周 31.9±2.0 30.2±2.4 3.629 ＜0.001 出生体重/g 1 693.2±426.3 1 356.0±375.8 3.525 0.001 5 min Apgar评分 9(9，10) 9(8，10) -2.373 0.018 顺产/例(%) 20(21.5) 7(29.2) 0.631 0.427 试管婴儿/例(%) 21(22.6) 6(25.0) 0.063 0.802 多胎妊娠(单/双)/例 56/37 13/11 0.288 0.591 宫内窘迫/例(%) 15(16.1) 6(25.0) 1.019 0.313 母亲年龄/岁 30.6±4.3 29.3±3.6 1.388 0.168 产妇诊断绒毛膜羊膜炎/例(%) 16(17.2) 4(16.7) 0.004 0.950 产前使用硫酸镁/例(%) 19(20.4) 8(33.3) 1.789 0.181 胎盘早剥/例(%) 5(5.4) 1(4.2) 0.057 0.811 胎盘早破/例(%) 30(32.3) 7(29.2) 0.084 0.772 胎盘置入/例(%) 2(2.2) 0(0) 0.525 0.469 前置胎盘/例(%) 6(6.5) 1(4.2) 0.177 0.674 妊娠糖尿病/例(%) 10(10.8) 0(0) 2.822 0.093 妊娠高血压综合征/例(%) 10(10.8) 3(12.5) 0.059 0.808 妊娠甲状腺功能减退/例(%) 2(2.2) 0(0) 0.525 0.469 新生儿支气管肺发育不良/例(%) 2(2.2) 7(29.1) 19.609 ＜0.001 新生儿呼吸窘迫综合征/例(%) 71(76.3) 23(95.8) 4.588 0.032 新生儿高胆红素血症/例(%) 65(69.9) 17(70.8) 0.008 0.928 新生儿败血症/例(%) 3(3.2) 1(4.2) 0.051 0.821 是否使用有创机械通气/例(%) 8(8.6) 6(25.0) 4.870 0.027 新生儿颅内出血/例(%) 12(12.9) 4(16.7) 0.229 0.632 住院天数/d 27(16，39) 44.5(27，67) -3.464 0.001
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表 4 早产儿听力复筛转诊的二元logistic回归分析
自变量 β 标准误 Walds χ2 P Exp(β) 95%CI 下限 上限 胎龄 0.131 0.224 0.344 0.557 1.140 0.735 1.769 出生体重 ＜0.001 0.001 0.062 0.803 1.000 0.997 1.002 5 min Apgar评分 -0.356 0.383 0.866 0.352 0.700 0.331 1.483 新生儿支气管肺发育不良 2.170 0.938 5.355 0.021 8.759 1.394 55.045 新生儿呼吸窘迫综合征 1.715 1.151 2.221 0.136 5.559 0.582 53.065 是否使用有创机械通气 0.912 0.796 1.312 0.252 2.489 0.523 11.850 住院天数 0.036 0.026 1.882 0.170 1.037 0.985 1.091 常量 -4.925 8.239 0.357 0.550 0.007 — —
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