Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Medical School at Houston, Houston, USA.
Am J Perinatol. 2011 Dec;28(10):767-72. doi: 10.1055/s-0031-1280858. Epub 2011 Jun 30.
We sought to quantify how often women with late preterm birth (LPTB) receive antenatal corticosteroid (ACS) therapy prior to 34 weeks and to determine its effects on neonatal respiratory morbidity. LPTBs (34 (0)/ (7) to 36 (6)/ (7) weeks) over a 1-year period at a single tertiary care hospital were studied. A composite neonatal respiratory outcome was defined as mechanical ventilation, continuous positive airway pressure with fraction of inspired oxygen (F IO(2)) >40% for >2 hours or F IO(2) >40% for >4 hours within the first 72 hours of life. Multivariate logistic regression analysis was used to evaluate the association between ACS therapy and neonatal respiratory morbidity. Over the study period, 503 LPTBs met the study criteria and 6.8% ( N = 34) had ACS therapy <34 weeks. Most had exposure >7 days prior to delivery (64.7%). Almost one-half of those receiving prior ACS therapy delivered between 34 and 35 weeks. There was no difference in the rate of prior ACS therapy based on LPTB indication for delivery. After adjusting for confounding factors, prior ACS therapy was not associated with lower respiratory morbidity (odds ratio [OR] 2.0, 95% confidence interval [CI] 0.2 to 16.3, P = 0.53). Advancing gestational age was the only variable associated with respiratory morbidity (OR 0.50, 95% CI 0.26 to .94, P = 0.03). In our population, prior ACS therapy was infrequent and was not associated with improvements in neonatal respiratory morbidity following LPTB.
我们旨在量化多少患有晚期早产（LPTB）的女性在 34 周前接受产前皮质类固醇（ACS）治疗，并确定其对新生儿呼吸发病率的影响。在一家单一的三级保健医院，对一年内的 LPTB（34（0）/（7）至 36（6）/（7）周）进行了研究。新生儿呼吸不良复合结局定义为机械通气、持续气道正压通气伴吸入氧分数（FIO2）>40%持续>2 小时或 FIO2>40%持续>4 小时在生命的前 72 小时内。多变量逻辑回归分析用于评估 ACS 治疗与新生儿呼吸发病率之间的关联。在研究期间，503 例 LPTB 符合研究标准，6.8%（N=34）有 ACS 治疗<34 周。大多数患者在分娩前有>7 天的暴露（64.7%）。近一半接受过先前 ACS 治疗的患者在 34 至 35 周之间分娩。根据 LPTB 分娩的指征，先前 ACS 治疗的发生率没有差异。在调整混杂因素后，先前 ACS 治疗与下呼吸道发病率无关（比值比[OR]2.0，95%置信区间[CI]0.2 至 16.3，P=0.53）。提前胎龄是唯一与呼吸发病率相关的变量（OR 0.50，95%CI 0.26 至.94，P=0.03）。在我们的人群中，先前 ACS 治疗的情况并不常见，并且与 LPTB 后新生儿呼吸发病率的改善无关。
