Department of Obstetrics and Gynecology, Edmond and Lily Safra Children Hospital, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Israel.
Am J Obstet Gynecol. 2012 Sep;207(3):222.e1-4. doi: 10.1016/j.ajog.2012.06.019. Epub 2012 Jun 30.
The purpose of this study was to determine whether corticosteroid administration after 34 weeks of gestation is associated with improved neonatal outcome in the presence of fetal lung immaturity.
We conducted a retrospective cohort study of women who underwent amniocentesis to determine fetal lung maturity from 34-37 weeks of gestation. Patients with negative results (167 women) received steroids based on physician preference and were categorized into 2 groups: study group treated with betamethasone (n = 83 women) and control group in which patients did not receive betamethasone therapy (n = 84 women). The 2 groups were compared with respect to neonatal outcomes. Composite neonatal morbidity was defined as the presence of respiratory distress syndrome, transient tachypnea of the newborn infant, or the need for respiratory support.
The rate of composite neonatal morbidity was significantly lower among infants who were exposed to steroids compared with the control group (8.4% vs 21%; P = .02). Multiple regression analysis revealed that corticosteroid administration was associated independently with the composite morbidity outcome.
Antenatal steroid administration after 34 weeks of gestation is associated with improved neonatal outcome and should be considered when fetal lung immaturity is documented.
本研究旨在探讨在胎儿肺不成熟的情况下，妊娠 34 周后给予皮质类固醇是否与新生儿结局改善有关。
我们对 34-37 孕周行羊膜穿刺术以确定胎儿肺成熟度的女性进行了回顾性队列研究。结果为阴性的患者（167 例）根据医生的建议接受皮质类固醇治疗，并分为 2 组：接受倍他米松治疗的研究组（n=83 例）和未接受倍他米松治疗的对照组（n=84 例）。比较两组新生儿结局。复合新生儿发病率定义为呼吸窘迫综合征、新生儿短暂性呼吸急促或需要呼吸支持的存在。
与对照组相比，暴露于皮质类固醇的婴儿复合新生儿发病率显著降低（8.4%比 21%；P=0.02）。多因素回归分析显示，皮质类固醇的应用与复合发病率的结局独立相关。
妊娠 34 周后给予产前皮质类固醇可改善新生儿结局，当胎儿肺不成熟时应考虑使用。
