Sledziewski A, Kinalski M, Kretowski A
Zakład Rozwoju Płodu i Noworodka, Instytut Matki i Dziecka w Białymstoku.
Przegl Lek. 2000;57(3):171-7.
Preterm delivery is still a major cause of infant morbidity and mortality. Premature infants develop numerous complications including respiratory distress syndrome, intraventricular hemorrhage, patent ductus arteriosus, necrotising enterocolitis, etc. Respiratory distress syndrome is the leading problem in perinatology. The incidence of RDS accounts for 70% of all infants delivered before 30 week's gestation and about 20% neonates born between 32-37 week of pregnancy. Our paper presents current opinions and is a critical review of relevant literature on antenatal treatment before anticipated preterm deliveries. Recently performed meta-analysis prove that glucocorticoid therapy is effective in reducing aforementioned pathologies of prematurity. After brief account on effects of several hormones on fetal pulmonary maturity some beneficial interactions for enhanced fetal maturity are pointed out. Glucocorticoid mechanism of action in target cells and its biochemical implications are reviewed. The use of antenatal corticoids for fetal maturation and possible adverse maternal effects follow. Finally both short-term and long-term benefits of ANS are discussed. Thus there are convincing data to support the use of ANS in fetal pulmonary maturation. The current findings suggest that the improvement of respiratory outcome may depend on enhanced expression of phospholipids and proteins of the surfactant system and enzymes of antioxidant systems. We believe that use of antenatal corticosteroids for fetal maturation results in improvement of neonatal outcome and yields substantial savings in health care costs.
早产仍然是婴儿发病和死亡的主要原因。早产儿会出现许多并发症，包括呼吸窘迫综合征、脑室内出血、动脉导管未闭、坏死性小肠结肠炎等。呼吸窘迫综合征是围产医学中的主要问题。呼吸窘迫综合征的发病率在妊娠30周前出生的所有婴儿中占70%，在妊娠32 - 37周出生的新生儿中约占20%。我们的论文提出了当前的观点，并对预期早产前的产前治疗相关文献进行了批判性综述。最近进行的荟萃分析证明，糖皮质激素疗法在减少上述早产相关病症方面是有效的。在简要介绍几种激素对胎儿肺成熟的影响后，指出了一些增强胎儿成熟的有益相互作用。综述了糖皮质激素在靶细胞中的作用机制及其生化影响。接着讨论了产前使用皮质类固醇促进胎儿成熟以及可能对母亲产生的不良影响。最后讨论了产前使用皮质类固醇的短期和长期益处。因此，有令人信服的数据支持产前使用皮质类固醇促进胎儿肺成熟。目前的研究结果表明，呼吸结局的改善可能取决于表面活性剂系统的磷脂和蛋白质以及抗氧化系统酶的表达增强。我们认为，产前使用皮质类固醇促进胎儿成熟可改善新生儿结局，并大幅节省医疗保健成本。
