Üstün Nuran, Hocaoğlu Meryem, Turgut Abdülkadir, Arslanoğlu Sertaç, Ovalı Fahri
Division of Neonatology, Department of Pediatrics, Göztepe Training and Research Hospital, Istanbul Medeniyet University, İstanbul, Turkey.
Department of Obstetrics and Gynecology, Göztepe Training and Research Hospital, Istanbul Medeniyet University, İstanbul, Turkey.
J Matern Fetal Neonatal Med. 2022 Jan;35(1):11-17. doi: 10.1080/14767058.2020.1808614. Epub 2020 Aug 28.
Infants who are born at 34 to 36 weeks of gestation (late preterm) are at greater risk for respiratory and other neonatal morbidities. The objective of this study was to examine the effects of administration of antenatal corticosteroids (ACSs) to women at risk for late preterm delivery on the incidence of neonatal outcomes.
This was a prospective cohort study of singleton gestations at risk of imminent delivery between 34 and 36 weeks. Neonatal outcomes were compared between mothers who received ACS and those who did not. Primary outcome was the rate of composite respiratory morbidity defined as the need for treatment within 72 h of life (continuous positive airway pressure or high flow nasal cannula for least 2 h or supplemental oxygen with a fraction of inspired oxygen of at least 0.30 for at least four continuous hours or mechanical ventilation).
During the 3-year study period, 595 subjects were included in this study, comprising 234 subjects that received ACS and 361 that did not. Administration of ACS significantly reduced the rates of composite respiratory morbidity (adjusted odds ratio (aOR) 0.63, 95% confidence interval (CI) 0.40-0.99), the use of CPAP or HFNC for at least 2 h (aOR 0.57, 95% CI 0.35-0.94) and transient tachypnea of newborn (aOR 0.48, 95% CI 0.28-0.82). Neonatal hypoglycemia was more significantly increased in the ACS group compared with controls (aOR 1.64, 95% CI 1.04-2.59). We found no significant between-group differences in the rate of respiratory distress syndrome, surfactant use, need for resuscitation, jaundice requiring phototherapy, admission to neonatal intensive care or special care nursery and duration of hospitalization.
Administration of ACS during the late preterm period decreased neonatal respiratory complications, however, increased the rate of hypoglycemia.
妊娠34至36周出生的婴儿（晚期早产儿）发生呼吸系统及其他新生儿疾病的风险更高。本研究的目的是探讨对有晚期早产风险的孕妇使用产前糖皮质激素（ACS）对新生儿结局发生率的影响。
这是一项对妊娠34至36周有即将分娩风险的单胎妊娠进行的前瞻性队列研究。比较接受ACS的母亲和未接受ACS的母亲的新生儿结局。主要结局是复合呼吸系统疾病发生率，定义为出生后72小时内需要治疗（持续气道正压通气或高流量鼻导管吸氧至少2小时，或吸入氧分数至少为0.30的补充氧气持续至少4小时，或机械通气）。
在3年的研究期间，本研究纳入了595名受试者，其中234名接受了ACS，361名未接受。使用ACS显著降低了复合呼吸系统疾病发生率（调整后的优势比（aOR）为0.63，95%置信区间（CI）为0.40 - 0.99）、使用持续气道正压通气或高流量鼻导管吸氧至少2小时的发生率（aOR为0.57，95% CI为0.35 - 0.94）以及新生儿短暂性呼吸急促的发生率（aOR为0.48，95% CI为0.28 - 0.82）。与对照组相比，ACS组新生儿低血糖症的发生率显著更高（aOR为1.64，95% CI为1.04 - 2.59）。我们发现两组在呼吸窘迫综合征发生率、表面活性剂使用情况、复苏需求、需要光疗的黄疸、入住新生儿重症监护病房或特殊护理病房以及住院时间方面无显著差异。
晚期早产期间使用ACS可降低新生儿呼吸系统并发症，但会增加低血糖症的发生率。
