Objectives To analyze long-term effects of antenatal betamethasone (≤16 mg, =24 mg and >24 mg) in preterm twins on infant and childhood morbidity. Methods Retrospective cohort study among 198 preterm twins. Three follow up time points, including a total of 84 outcomes, were evaluated: first neonatal examination after birth and in the neonatal period up to 10 days after birth using data from the clinic charts; examination from the 21st to the 24th month of life and examination from the 60th to the 64th months, using data from copies of the children’s examination booklets sent back by the parents. Dosage-dependent and sex-specific long-term effects of antenatal betamethasone treatment on neonatal, infant and early childhood development and morbidity up to 5.3 years of age were analyzed. Results Dosage escalation of >24 mg was not associated with improved neonatal, infant or early child hood outcome, independent of twin pair structure. In contrast, higher doses >24 mg were significantly linked to increased rates of congenital infections (OR 5.867, 95% CI 1.895–18.167). Male sex as a factor was obvious for lower rates of apnea-bradycardia-syndrome in neonates, higher rates of no free steps after 15 months in infancy and highest rates of motor clumsiness in early childhood. Conclusions Betamethasone dosage escalation >24 mg in twins born between 23+5 and 33+6 weeks of gestation did not improve neonatal, infant or early childhood morbidity. In contrast, higher doses >24 mg total dose resulted in significantly higher rates of congenital infections and are not recommended. For males, 24 mg betamethasone appears to be the preferable dose.

中文翻译：

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早产双胎妊娠中增加产前类固醇的剂量并不能改善长期结局

目的 分析产前倍他米松（≤16 mg、=24 mg 和 >24 mg）对早产双胞胎婴儿和儿童发病率的长期影响。方法对198对早产双胞胎进行回顾性队列研究。评估了三个随访时间点，包括总共 84 个结果：出生后的第一次新生儿检查和出生后长达 10 天的新生儿检查，使用临床图表中的数据；使用父母寄回的孩子考试手册副本中的数据，从生命的第 21 个月到第 24 个月进行考试，从第 60 个月到第 64 个月进行考试。分析了产前倍他米松治疗对新生儿、婴儿和儿童早期发育和发病率直至 5.3 岁的剂量依赖性和性别特异性长期影响。结果剂量递增> 24 mg 与改善新生儿、婴儿或早期儿童的结果无关，与双胞胎结构无关。相反，>24 mg 的较高剂量与先天性感染率增加显着相关（OR 5.867，95% CI 1.895–18.167）。男性作为一个因素是显而易见的，因为新生儿呼吸暂停-心动过缓综合征的发生率较低，婴儿期 15 个月后无自由步的发生率较高，儿童早期运动笨拙的发生率最高。结论 23 岁之间出生的双胞胎中倍他米松剂量增加 >24 mg 男性作为一个因素是显而易见的，因为新生儿呼吸暂停-心动过缓综合征的发生率较低，婴儿期 15 个月后无自由步的发生率较高，儿童早期运动笨拙的发生率最高。结论 23 岁之间出生的双胞胎中倍他米松剂量增加 >24 mg 男性作为一个因素是显而易见的，因为新生儿呼吸暂停-心动过缓综合征的发生率较低，婴儿期 15 个月后无自由步的发生率较高，儿童早期运动笨拙的发生率最高。结论 23 岁之间出生的双胞胎中倍他米松剂量增加 >24 mg+5和 33+6妊娠数周并未改善新生儿、婴儿或儿童早期的发病率。相反，总剂量大于 24 mg 的较高剂量会导致先天性感染率显着升高，因此不推荐使用。对于男性，24 mg 倍他米松似乎是优选的剂量。