Jessica Liauw, Kayleigh S J Campbell, Hannah Foggin, Ruth E Grunau, Julie Petrie, Anila Qasim, Romina Brignardello-Petersen, Ram A Mishaal, Jennifer A Hutcheon
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引用次数: 0
摘要
目的：通过设计最小化混杂风险的研究，确定产前皮质类固醇给药对儿童神经发育结局的影响。数据来源：我们检索了MEDLINE、EMBASE和Cochrane Central Register of Controlled Trials数据库，从开始到2024年7月24日，没有语言限制。研究选择方法：两名评论者独立选择随机和观察性比较研究，这些研究具有很强的设计来控制未测量的混淆（即准实验研究），这些研究评估了1-18岁的后代在产前接受一个疗程的皮质类固醇治疗与安慰剂或未接受治疗的神经发育结局。制表、整合和结果：两位审稿人独立提取数据并评估偏倚风险。我们使用随机效应荟萃分析来综合基于儿童神经发育临床专家对合用适当性的盲法判断的结果。我们使用GRADE（推荐评估、发展和评价分级）来评估证据的确定性。共纳入14项研究，包括8项随机对照试验随访研究[n= 2233]和6项准实验研究[n= 277679]。大多数检查的神经发育结果（19/23）显示与产前皮质类固醇给药无关。我们发现，在产前接触皮质类固醇的儿童中，非语言智力和视觉记忆得分的风险略有降低。对于一般发育和一般行为，随机试验随访研究分别显示出轻微保护作用和无效作用的不显著趋势，但准实验研究显示风险增加。在低或中等偏倚风险的研究中，我们发现产前皮质类固醇给药与儿童不良神经发育之间没有关联。结论：没有一致的证据表明产前皮质类固醇与儿童神经发育受损的风险增加有关，这些研究具有强大的混杂控制设计。系统评价注册号：PROSPERO， CRD42021238558。
Antenatal Corticosteroids and Child Neurodevelopment: A Systematic Review and Meta-analysis.
Objective: To determine the effect of antenatal corticosteroid administration on childhood neurodevelopmental outcomes from studies that have a design that minimized the risk of confounding.
Data sources: We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases from inception to July 24, 2024, without language restrictions.
Methods of study selection: Two reviewers independently selected randomized and observational comparative studies with a strong design to control for unmeasured confounding (ie, quasi-experimental studies), which evaluated neurodevelopmental outcomes among offspring aged 1-18 years who were exposed to one course of antenatal corticosteroid administration compared with placebo or no treatment.
Tabulation, integration, and results: Two reviewers independently extracted data and assessed risk of bias. We used random-effects meta-analyses to synthesize outcomes based on blinded adjudication of appropriateness for pooling by clinical experts in child neurodevelopment. We evaluated the certainty of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation). A total of 14 studies (eight randomized controlled trial follow-up studies [n=2,233] and six quasi-experimental studies [n=277,679]) were included. Most neurodevelopmental outcomes examined (19/23) showed no association with antenatal corticosteroid administration. We found modestly decreased risks of nonverbal intelligence and visual memory scores among children exposed to antenatal corticosteroids. For general development and general behavior, randomized trial follow-up studies showed a nonsignificant trend toward a small protective and null effect, respectively, but quasi-experimental studies showed an increased risk. Among studies with low or moderate risk of bias, we found no association between antenatal corticosteroid administration and adverse child neurodevelopment.
Conclusion: There is no consistent evidence that antenatal corticosteroids are associated with an increased risk of impaired childhood neurodevelopment among studies with a strong design to control for confounding.
期刊介绍：
"Obstetrics & Gynecology," affectionately known as "The Green Journal," is the official publication of the American College of Obstetricians and Gynecologists (ACOG). Since its inception in 1953, the journal has been dedicated to advancing the clinical practice of obstetrics and gynecology, as well as related fields. The journal's mission is to promote excellence in these areas by publishing a diverse range of articles that cover translational and clinical topics.
"Obstetrics & Gynecology" provides a platform for the dissemination of evidence-based research, clinical guidelines, and expert opinions that are essential for the continuous improvement of women's health care. The journal's content is designed to inform and educate obstetricians, gynecologists, and other healthcare professionals, ensuring that they stay abreast of the latest developments and best practices in their field.
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