Ring Allison M, Garland Jeffery S, Stafeil Brian R, Carr Margaret H, Peckman Gail S, Pircon Richard A
Department of Obstetrics and Gynecology, Medical College of Wisconsin Affiliated Hospitals, St. Joseph Regional Medical Center, Milwaukee, WI, USA.
Am J Obstet Gynecol. 2007 May;196(5):457.e1-6. doi: 10.1016/j.ajog.2006.12.018.
This study was undertaken to determine whether the neonatal benefit of a single complete course of antenatal corticosteroids diminishes when delivery is remote from administration (> 14 days).
This retrospective 2 center cohort trial included women who received a single complete course of antenatal corticosteroids and delivered a viable singleton infant between 26 and 34 weeks of gestation. Patients were divided into 1 of 2 groups on the basis of the interval from first corticosteroid dose to delivery (2-14 days and > 14 days). Neonatal outcomes among treatment groups were stratified by gestational age at delivery (< 28 weeks, > or = 28 weeks). Regression models were used to control for potential confounders.
Three hundred fifty-seven pregnancies were included, of which 98 women delivered at > 14 days after antenatal corticosteroids. Neonates at > or = 28 weeks of gestation and who delivered at > 14 days after antenatal corticosteroids were more likely to require surfactant therapy (60% vs 48%; p = .02) and to require ventilatory support for > 24 hours (58% vs 46%; P = .02). Differences in outcomes between groups remained in regression models that were controlled for confounders. There was no significant difference between treatment groups for neonates who delivered at < 28 weeks of gestation. Rates of survival without chronic lung disease and intraventricular hemorrhage were similar between groups.
A time interval of > 14 days between the administration of antenatal corticosteroids and delivery is associated with an increased risk for ventilatory support and surfactant use in neonates who deliver at > 28 weeks of gestation.
本研究旨在确定当分娩距离产前使用单剂完整疗程的皮质类固醇时间较远（>14天）时，其对新生儿的益处是否会降低。
这项回顾性双中心队列试验纳入了接受单剂完整疗程产前皮质类固醇治疗并在妊娠26至34周分娩出存活单胎婴儿的女性。根据从首次使用皮质类固醇剂量到分娩的时间间隔（2 - 14天和>14天），将患者分为两组。治疗组的新生儿结局按分娩时的孕周分层（<28周、≥28周）。使用回归模型控制潜在的混杂因素。
纳入357例妊娠，其中98名女性在产前皮质类固醇治疗后>14天分娩。孕周≥28周且在产前皮质类固醇治疗后>14天分娩的新生儿更有可能需要表面活性剂治疗（60%对48%；p = 0.02），并且需要通气支持>24小时（58%对46%；P = 0.02）。在控制了混杂因素的回归模型中，两组之间的结局差异仍然存在。对于孕周<28周分娩的新生儿，治疗组之间没有显著差异。两组之间无慢性肺部疾病和脑室内出血的存活率相似。
产前皮质类固醇给药与分娩之间的时间间隔>14天，与孕周>28周分娩的新生儿通气支持和表面活性剂使用风险增加有关。
