Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Maternal-Fetal Medicine, University of Cincinnati School of Medicine, Cincinnati, OH 45229, USA.
Obstet Gynecol. 2012 May;119(5):909-16. doi: 10.1097/AOG.0b013e31824ea4b2.
To estimate whether antenatal corticosteroids given after fetal lung immaturity in pregnancies at 34 weeks of gestation or more would improve neonatal outcomes and, in particular, respiratory outcomes.
We compared outcomes of 362 neonates born at 34 weeks of gestation or more after fetal lung maturity testing: 102 with immature fetal lung indices were treated with antenatal corticosteroids followed by planned delivery within 1 week; 76 with immature fetal lung indices were managed expectantly; and 184 were delivered after mature amniocentesis. Primary outcomes were composites of neonatal and respiratory morbidity.
Compared with corticosteroid-exposed neonates those born after mature amniocentesis had lower rates of adverse neonatal (26.5% compared with 14.1%, adjusted odds ratio [OR] 0.51, 95% confidence interval [CI] 0.27-0.96) and adverse respiratory outcomes (9.8% compared with 3.3%, adjusted OR 0.33, 95% CI 0.11-0.98); newborns born after expectant management had significantly less respiratory morbidity (1.3% compared with 9.8%, adjusted OR 0.11, 95% CI 0.01-0.92) compared with corticosteroid-exposed newborns.
Administration of antenatal corticosteroids after immature fetal lung indices did not reduce respiratory morbidity in neonates born at 34 weeks of gestation or more. Our study supports prolonging gestation until delivery is otherwise indicated.
II.
评估在妊娠 34 周或以上胎儿肺不成熟时给予产前皮质类固醇是否会改善新生儿结局，特别是呼吸结局。
我们比较了 362 例在胎儿肺成熟试验后 34 周或以上出生的新生儿的结局：102 例胎儿肺指数不成熟的新生儿接受产前皮质类固醇治疗，随后在 1 周内计划分娩；76 例胎儿肺指数不成熟的新生儿接受期待治疗；184 例在羊水成熟后分娩。主要结局是新生儿和呼吸发病率的综合指标。
与皮质类固醇暴露的新生儿相比，羊水成熟后分娩的新生儿不良新生儿（26.5%比 14.1%，调整后的优势比[OR]0.51，95%置信区间[CI]0.27-0.96）和呼吸不良结局（9.8%比 3.3%，调整后的 OR 0.33，95%CI 0.11-0.98）的发生率较低；期待治疗后的新生儿呼吸发病率明显较低（1.3%比 9.8%，调整后的 OR 0.11，95%CI 0.01-0.92）与皮质类固醇暴露的新生儿相比。
在胎儿肺指数不成熟时给予产前皮质类固醇并不能降低妊娠 34 周或以上出生的新生儿的呼吸发病率。我们的研究支持延长妊娠直到有其他指征为止。
II。
