Dola Chi, Tran Thuc, Linhuber Anne-Marie, Cierny Jill, Denicola Nathaniel, Chong Euming, Bhuiyan Azad
Department of Obstetrics & Gynecology, Tulane School of Medicine, New Orleans, Louisiana 70112, USA.
J Matern Fetal Neonatal Med. 2011 Jan;24(1):73-8. doi: 10.3109/14767058.2010.481319. Epub 2010 May 12.
To determine the frequency of immediate morbidities in neonates with evidence of mature fetal lung indices who delivered before 37 weeks gestation.
A retrospective analysis was performed on pregnancies resulting in birth at < 37 weeks after mature fetal lung was documented by phosphatidylglycerol, lecithin/sphingomyelin ratio, or TDx-FLM studies. Pregnancies with multifetal gestations, maternal diabetes, or fetal anomalies were excluded.
179 patients were included. Eighty-one (45.3%) neonates did not sustain any morbidity, and 98 (54.7%) neonates sustained one or more morbidities. Compared to neonate without any morbidity, neonates experiencing morbidities were delivered at significantly younger gestation (35.7 ± 1.1 vs. 34.9 ± 1.5 weeks, respectively, p < 0.001) had lower birth- weight (2632.2 ± 475.5 vs. 2395.3 ± 496 g, respectively, p < 0.001), and required longer hospital stay (3.7 ± 2.8 vs. 6.9 ± 7.5 days, p < 0.001). A multivariate regression model was performed to control for the effect of birth-weight, steroid administration, and preterm premature rupture of membrane. An earlier gestational age at delivery was associated with a higher risk of neonatal morbidity. The risk of neonatal morbidity decreased by 40% (OR = 0.60, 95% CI = 0.41-0.88; p = 0.009) for each 1 week increase in gestational age.
Even in the presence of documented fetal lung maturity, major morbidities--including respiratory distress - may still occur.
确定妊娠37周前分娩且有成熟胎儿肺指标证据的新生儿即刻发病的频率。
对通过磷脂酰甘油、卵磷脂/鞘磷脂比值或TDx - FLM研究记录到成熟胎儿肺后在<37周出生的妊娠进行回顾性分析。排除多胎妊娠、母体糖尿病或胎儿异常的妊娠。
纳入179例患者。81例（45.3%）新生儿未出现任何发病情况，98例（54.7%）新生儿出现一种或多种发病情况。与未出现任何发病情况的新生儿相比，出现发病情况的新生儿分娩时孕周明显更小（分别为35.7±1.1周和34.9±1.5周，p<0.001），出生体重更低（分别为2632.2±475.5克和2395.3±496克，p<0.001），且住院时间更长（3.7±2.8天和6.9±7.5天，p<0.001）。进行多因素回归模型以控制出生体重、类固醇给药和胎膜早破的影响。分娩时孕周越早，新生儿发病风险越高。孕周每增加1周，新生儿发病风险降低40%（OR = 0.60，95%CI = 0.41 - 0.88；p = 0.009）。
即使有记录显示胎儿肺成熟，包括呼吸窘迫在内的主要发病情况仍可能发生。
