Sotiriadis Alexandros, Makrydimas George, Papatheodorou Stefania, Ioannidis John Pa
Department of Hygiene and Epidemiology, Clinical Trials and Evidence-based Medicine Unit, University of Ioannina School of Medicine, University Campus, Ioannina, Greece, 45110.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD006614. doi: 10.1002/14651858.CD006614.pub2.
Infants born at term by elective caesarean delivery are more likely to develop respiratory morbidity than infants born vaginally. Prophylactic corticosteroids in singleton preterm pregnancies accelerate lung maturation and reduce the incidence of respiratory complications.
The objective of this review was to assess the effect of prophylactic corticosteroid administration before elective caesarean section at term, as compared to usual management without corticosteroids, in reducing neonatal respiratory morbidity and admission to special care with respiratory complications.
We searched the Cochrane Pregnancy and Chilbirth Group's Trials Register (30 June 2009).
Randomised and quasi-randomised controlled trials comparing prophylactic antenatal corticosteroid administration (betamethasone or dexamethasone) with placebo or with no treatment, given before elective caesarean section at term (at or after 37 weeks of gestation).
The co-authors assessed the results of the only available trial independently to retrieve data on perinatal outcomes. Results were expressed as risk ratio (RR) or mean differences (MD), together with their 95% confidence intervals (CI).
One study comparing prophylactic administration of betamethasone (N = 467) versus usual treatment without steroids (N = 475) in term elective caesarean section was included in the review. Women randomised to treatment group received two intramuscular doses of betamethasone in the 48 hours before delivery, whereas the control group received treatment as usual.Prophylactic betamethasone appeared to significantly decrease the risk of admission to the neonatal intensive care unit for respiratory morbidity (RR 0.15; 95% CI 0.03 to 0.64). However, no statistically significant reduction was found in the incidence of neonatal respiratory distress syndrome (RR 0.32; 95% CI 0.07 to 1.58), transient tachypnoea of the newborn (RR 0.52; 95% CI 0.25 to 1.11), need for mechanical ventilation (RR 4.07; 95% CI 0.46 to 36.27) and length of stay in neonatal intensive care unit (MD) -2.14 days; 95% CI -5.58 to 1.30).There were no reported events of neonatal sepsis, perinatal deaths or maternal trauma infection, therefore results on these outcomes are non-estimable. The study did not provide data on other pre-defined outcomes.
AUTHORS' CONCLUSIONS: The results from the single trial are promising, but more studies with larger samples are needed to investigate the effect of prophylactic steroids in the incidence of neonatal complications per se. Also more data and longer follow up would be needed for potential harms and complications.
与经阴道分娩的婴儿相比，择期剖宫产出生的足月儿更易出现呼吸系统疾病。单胎早产妊娠中预防性使用皮质类固醇可加速肺成熟并降低呼吸系统并发症的发生率。
本综述的目的是评估足月择期剖宫产术前预防性使用皮质类固醇与不使用皮质类固醇的常规处理相比，在降低新生儿呼吸系统疾病及因呼吸系统并发症入住特殊护理病房方面的效果。
我们检索了Cochrane妊娠与分娩组试验注册库（2009年6月30日）。
随机和半随机对照试验，比较足月择期剖宫产（妊娠37周及以后）前预防性产前使用皮质类固醇（倍他米松或地塞米松）与安慰剂或不治疗的效果。
共同作者独立评估了唯一一项可用试验的结果，以获取围产期结局的数据。结果以风险比（RR）或平均差（MD）及其95%置信区间（CI）表示。
本综述纳入了一项比较足月择期剖宫产中预防性使用倍他米松（N = 467）与不使用类固醇的常规治疗（N = 475）的研究。随机分配至治疗组的女性在分娩前48小时接受两次肌肉注射倍他米松，而对照组接受常规治疗。预防性使用倍他米松似乎显著降低了因呼吸系统疾病入住新生儿重症监护病房的风险（RR 0.15；95% CI 0.03至0.64）。然而，未发现新生儿呼吸窘迫综合征的发生率有统计学显著降低（RR 0.32；95% CI 0.07至1.58），新生儿短暂性呼吸急促的发生率也未降低（RR 0.52；95% CI 0.25至1.11），机械通气需求未降低（RR 4.07；95% CI 0.46至36.27），新生儿重症监护病房住院时间也未缩短（MD -2.14天；95% CI -5.58至1.30）。未报告新生儿败血症、围产期死亡或产妇创伤感染事件，因此这些结局的结果无法评估。该研究未提供其他预定义结局的数据。
单项试验的结果很有前景，但需要更多更大样本的研究来调查预防性使用类固醇对新生儿并发症发生率本身的影响。对于潜在危害和并发症，也需要更多数据和更长时间的随访。
