Kattner E, Metze B, Waiss E, Obladen M
Department of Neonatology, Children's Hospital, University Clinics Rudolf Virchow, Berlin, Fed. Rep. of Germany.
J Perinat Med. 1992;20(6):449-57. doi: 10.1515/jpme.1992.20.6.449.
A meta-analysis was performed of 9 controlled trials of maternal beta-/dexamethasone treatment in which the incidence of RDS in infants born before 30 weeks gestation was reported. A significant decrease could be shown in 250 immature infants. The number of cases was to small for analysis of lower gestational ages or for the demonstration of a reduction in mortality. In a separate study of 135 infants born before 30 weeks gestation tracheal aspirate phospholipid analysis was performed using thin layer chromatography. 64 of them had been exposed prenatally to steroids. Significantly more of these infants had a mature L/S ratio > or = 2.7 (p < 0.02) and prenatal glucocorticoid treatment was associated with a markedly increased survival rate (odds ratio 2.4, p < 0.02). We conclude from the meta-analysis of the literature and from the findings of our study, that accelerated lung maturation follows prenatal steroid treatment with a reduction in RDS-incidence even in very immature fetuses. Consequently it would be appropriate to administer glucocorticoids combined with tocolysis since this has been shown to be beneficial for those women threatening to deliver prematurely at less than 30 weeks gestation.
对9项关于母体β- /地塞米松治疗的对照试验进行了荟萃分析，这些试验报告了妊娠30周前出生婴儿的呼吸窘迫综合征（RDS）发病率。在250名未成熟婴儿中可显示出显著下降。病例数过少，无法分析更低孕周的情况或证明死亡率降低。在一项对135名妊娠30周前出生婴儿的单独研究中，使用薄层色谱法进行气管吸出物磷脂分析。其中64名婴儿在产前接触过类固醇。这些婴儿中，成熟的卵磷脂/鞘磷脂（L/S）比值>或= 2.7的明显更多（p < 0.02），产前糖皮质激素治疗与存活率显著提高相关（优势比2.4，p < 0.02）。我们从文献的荟萃分析和我们的研究结果得出结论，产前类固醇治疗后肺成熟加速，RDS发病率降低，即使在非常不成熟的胎儿中也是如此。因此，给予糖皮质激素联合宫缩抑制剂是合适的，因为这已被证明对那些有在妊娠小于30周时早产风险的妇女有益。
