产前皮质类固醇和儿童神经发育:系统性审查和元分析
Jessica Liauw1, Kayleigh S J Campbell, Hannah Foggin
1Department of Obstetrics and Gynaecology and the Department of Pediatrics, University of British Columbia, the BC Children's Hospital Research Institute, and the Neonatal Follow-up Program, Department of Psychology, Children's & Women's Health Centre of British Columbia, Vancouver, British Columbia, the Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, and the Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
产前皮质类固醇没有显示出对儿童神经发育有害的一致证据. 具有强烈设计的研究发现,这些治疗方法与儿童的神经发育不良结果之间没有关联.
科学领域:
- 围产儿医学 围产儿医学
- 发育儿科 发育儿科
- 证据综合 证据综合
背景情况:
- 产前皮质类固醇用于促进胎儿肺部成熟.
- 有关在子宫中暴露的儿童潜在的神经发育影响存在担忧.
- 需要高质量的证据来评估这些风险.
研究的目的:
- 评估产前皮质类固醇对儿童神经发育结果的影响.
- 专注于具有强大的设计,尽量减少混因素的研究.
主要方法:
- 随机对照试验和准实验研究的系统审查和元分析.
- 在MEDLINE,EMBASE和Cochrane数据库中搜索到2024年7月.
- 使用GRADE评估偏差风险和证据确定性.
主要成果:
- 包括14项研究 (8项RCT后续研究,6项准实验) 涉及超过28万名儿童.
- 在23个神经发育结果中,有19个没有与产前皮质类固醇相关.
- 观察到非语言智力和视觉记忆的风险略有降低;在偏差研究的低/中等风险中没有发现任何关联.
结论:
- 没有一致的证据将产前皮质类固醇与儿童神经发育受损的风险增加联系在一起.
- 具有强大的设计控制混的研究不支持与不良结果的关联.
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