Ventolini G, Neiger R, Hood D L, Belcastro M R
Department of Obstetrics and Gynecology, Wright State University, Dayton, OH 45409, USA.
J Perinatol. 2006 May;26(5):264-7. doi: 10.1038/sj.jp.7211501.
To compare the neonatal outcome of infants delivered before 39 weeks' gestation following documentation of fetal lung maturity before and after the lamellar body count (LBC) threshold was increased from 30,000 to 50,000 LB/ul. We discuss the algorithm employed for testing fetal lung maturity, the cost of testing and potential savings.
We studied the outcome of infants delivered electively before 39 weeks' gestation after fetal lung maturity was documented by amniotic fluid analysis. We compared the outcome of neonates born before and after the LBC threshold was increased.
Our cohort included 527 neonates who were divided into two groups: 264 who underwent fetal lung maturity studies before the change in LBC threshold and 263 who underwent testing after the change. In the first group, 158 neonates met the criteria of LBC >30,000 LB/ul and were delivered without further testing. The second group included 154 neonates who were mature by LBC >50,000 LB/ul and were delivered. Seven of the neonates born in the first group required admission to the neonatal intensive care unit (NICU), whereas in the second group only two neonates required admission (P = 0.02). Additionally, 16 neonates in the first group required respiratory assistance compared with six in the second group (P = 0.04). The overall neonatal complication rate was significantly higher in the first group (P = 0.001).
Changing the LBC threshold resulted in a significant decrease in neonatal morbidity. Employing the algorithm, we described for testing fetal lung maturity is cost effective, and more importantly, represents sound evidence-based medical management.
比较在板层小体计数（LBC）阈值从30,000提高到50,000 LB/ul前后，孕39周前分娩的婴儿的新生儿结局。我们讨论了用于检测胎儿肺成熟度的算法、检测成本和潜在节省情况。
我们研究了在通过羊水分析记录胎儿肺成熟度后，择期在孕39周前分娩的婴儿的结局。我们比较了LBC阈值提高前后出生的新生儿的结局。
我们的队列包括527名新生儿，分为两组：264名在LBC阈值改变前进行了胎儿肺成熟度研究，263名在改变后进行了检测。在第一组中，158名新生儿符合LBC>30,000 LB/ul的标准，无需进一步检测即可分娩。第二组包括154名通过LBC>50,000 LB/ul判定为成熟的新生儿并进行了分娩。第一组出生的7名新生儿需要入住新生儿重症监护病房（NICU），而第二组只有2名新生儿需要入住（P = 0.02）。此外，第一组有16名新生儿需要呼吸辅助，而第二组有6名（P = 0.04）。第一组的总体新生儿并发症发生率显著更高（P = 0.001）。
改变LBC阈值导致新生儿发病率显著降低。采用我们描述的检测胎儿肺成熟度的算法具有成本效益，更重要的是，代表了合理的循证医学管理。
