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Antenatal glucocorticoid hormones (glucocorticoids, GCS) as the promotion of the lungs of premature children mature strategy has been widely used in the clinical role of GCS longest time limit of one week, such as childbirth, treatment interval over seven days of its protective effect disappeared, while about 50% of pregnant women are yet to accept a course of GCS 7-14 days after childbirth, obstetricians This has prompted repeated dosing of pregnant women there is still the risk of preterm delivery. Animal model study results indicate that prenatal repeated use GCS to have a negative impact on the growth and development of the fetal lung, nervous system, the prenatal hormone dose and the degree of brain damage as a positive correlation, but there is no consensus on the clinical aspects of the reported prenatal whether repeated application of GCS caused scholars increasingly controversial. The experiment, cortisol and growth and development of the follow-up (NBNA score and the CDCC score) to investigate the possible effects of multiple courses of antenatal GCS human fetal brain development, in order to guide the clinical treatment of preterm children stress and non-stress. Objects and methods from August 2005 to January 2007 hospital PICU admitted to 27 to 34 weeks, 118 cases of premature children, prenatal hormone divided into three groups: group Ⅰ control group, group II for a single course dexamethasone group, Ⅲ group multiple courses of dexamethasone group, premature children were given symptomatic and supportive treatment, clinical observation birth weight, head circumference, length, stress and non-stress serum cortisol concentration mortality, the incidence of hyaline membrane disease (RDS) RDS clinical treatment of the case, the incidence of intraventricular hemorrhage (IVH), corrected gestational age to the expected date of birth 20 underwent neonatal behavioral neurological assessment (NBNA) correct tire the age of 3 months after birth, 6 months, 12 months and 18 months CDCC intelligence (MDI) and motor development (PDI) detection, and 12-18 months of cerebral palsy and other sequelae observed incidence. Results 1 GENERAL INFORMATION: premature children of 118 cases of group Ⅰ 39 cases, Ⅱ group 40 cases, Ⅲ group of 39 cases, the premature children in general, perinatal circumstances, the male to female ratio, gestational age, birth way ( vaginal delivery and cesarean section), gestational age, preterm children with complications such as congenital infection, asphyxia, infection of the newborn and the mother's pregnancy complications such as pregnancy-induced hypertension, diabetes and other influencing factors had no significant difference (P> 0.05), comparable. 1) was born 2 clinical observation of the growth and development indicators: birth weight, multi-course group was significantly less than the average weight of a single treatment group and did not use hormone group (P = 0.001), a significant difference, there is a statistically significant; single treatment group and not no significant differences compared with hormone group. Length aspects, multi-treatment group, the average length of 40.00 ± 2.66cm, single treatment group was 42.05 ± 3.69cm, unused the hormone group average of 41.61 ± 3.86cm (P = 0.074), the difference was not statistically significant; head circumference, more treatment group was 27.67 ± 1.30cm, single treatment group was 29.47 ± 2.01cm, unused hormone group average of 29.01 ± 2.25 cm (P = 0.001), the difference was statistically significant, single treatment group with not using hormone group compared No difference. RDS 2) after the birth of the incidence of RDS and intraventricular hemorrhage (IVH): multi-treatment group was 33%, a single course of treatment group was 35%, and did not use the hormone group was 59%, compared with a single course of multiple courses of no significant difference , but two sets of the same is not the hormone group compared to significantly reduce the incidence of RDS (P = 0.001), significant differences was statistically significant. Multiple courses and a single course of prenatal hormone treatment significantly reduced the utilization rate of mechanical ventilation and duration of mechanical ventilation, hospitalization time, between the two groups and no difference. Multiple courses of dexamethasone group IVH incidence of 46% in a single treatment group was 20%, 33% in the control group, multi-treatment and the incidence of IVH in the control group was significantly higher than a single course of treatment group, P <0.05, significant difference, statistically significant. 3) after the birth of the concentration of serum cortisol under stress and non-stress: Stress state of multiple courses of serum cortisol concentrations were 9.83 ± 4.77ug/dl, 13.65 ± 9.13ug/dl single treatment group and the control group 6.05 ± 4.59ug/dl, P> 0.05, the difference was not statistically significant; the stress multiple courses serum cortisol concentrations were 4.56 ± 2.88ug/dl single treatment group 4.25 ± 3.29ug/dl The control group was 5.31 ± 3.15 ug / dl, P values> 0.05, the difference was not statistically significant; 4) in-hospital mortality: multiple courses hospital mortality rate was 11%, a single course of treatment group was 7.5%, the control group was 28% (P <0.05), multi-course and single course of treatment group than in the control group and significantly reduce the mortality rate of premature children, a significant difference was statistically significant, but no significant difference between the two groups. The 3 developmental follow-up 1) the neurobehavioral determination: three groups of children were born prematurely in the correct gestational age up to the expected date of birth and up to pre-production period of seven days after NBNA detection, single-treatment group score significantly higher than that in the control group and multi-course group, P values ??<0.05, significant difference was statistically significant. 2) infants the CDCC smart development assessment: corrected gestational age after birth to 3 months, and multiple courses of dexamethasone group mental development index (MDI) 94.11 ± 14.97 and psychomotor development index (PDI) for 97.77 ± 14.84 single course group of MDI 110.54 ± 10.05 and PDI, 112.41 ± 11.55, control group MDI 106.79 ± 9.95 and PDI112.31, ± 6.42, the three groups significant differences. 6 months multiple courses of dexamethasone MDI and PDI 100.80 ± 14.07 to 92.94 ± 15.42, single-course group MDI 109.19 ± 10.60 and PDI 106.59 ± 14.69, control group MDI 103.46 ± 12.53 and PDI 95.54 ± 11.58, three groups have significantly differences. Although the follow-up of 12 months the number of cases is different, but the three groups of MDI and PDI test results by statistical analysis showed significant differences in the multi-treatment group was significantly lower than that of a single course of treatment and control group, a single treatment group was higher. 3) 1-year-old and 1-year-old half neurobehavioral abnormalities analysis: multi-treatment group, 3/10, single treatment group, 1/12 3/10 in the control group, abnormal behavior is mainly manifested as hyperactivity, attention deficit, language retardation and cerebral palsy. Conclusions Prenatal application the GCS can significantly reduce the incidence and mortality of premature child RDS, but no difference between single treatment and multiple courses. Over two courses GCS long-term development of the nervous system in preterm children nearly have some adverse effects; 3 prenatal single treatment is effective and glucocorticoids, should avoid repeated use of corticosteroids.
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