Hospital Tuanku Ja'afar, Obstetrics and Gynaecology Department, Seremban, Malaysia.
Hospital Tuanku Ja'afar, Paediatric Department, Seremban, Malaysia.
Med J Malaysia. 2021 Sep;76(5):624-629.
The use of intramuscular (IM) dexamethasone injections before an elective caesarean delivery at term has been shown in multiple randomized controlled trials to reduce the rates of transient tachypnoea of the newborn, and admission to neonatal care. Recent studies have suggested that a complete course of IM steroids can be associated with long term harmful consequences to the infants born, and there have been studies suggesting that a lower dose of IM corticosteroids can be beneficial. Therefore, we aim to establish if halving the dose of dexamethasone to 12mg can demonstrate any benefit for term elective caesarean section deliveries whilst minimizing foetal exposure.
An observational controlled study comparing neonatal respiratory morbidities before and after the single dose 12mg dexamethasone was implemented in our obstetrics and gynaecology centre for term elective caesarean section deliveries. We included singleton pregnancies from 37+0 to 38+6 weeks undergoing elective caesarean section into our study. A total of 674 patients fulfilled the inclusion criteria and were recruited. We compared the rates and duration of admission to neonatal intensive care unit, the need for mechanical ventilation and the rate of transient tachypnoea of the newborn in the first half of 2019 without IM dexamethasone injections against the second half of the year when a single dose IM dexamethasone was given.
IM dexamethasone injection did not show any significant benefit with regards to reducing the admission to neonatal care (OR 0.97, p- value 0.69), admission to neonatal intensive care unit (OR 0.91, p- value 0.80), the need for mechanical ventilation (OR 0.98, p- value 0.95), and the incidence of transient tachypnoea of the newborn (OR1.01, p- value 0.96). There was also no significant difference for the duration of admission in the neonatal intensive care unit for both groups (p- value 0.17).
This study showed that there was no significant benefit gained from the lower dose antenatal corticosteroids for term elective caesarean section deliveries and considering that there have been long term harmful consequences demonstrated from the higher dose of antenatal corticosteroids at term, this practice should therefore be discontinued until a larger study is done to refute these findings. The use of such dexamethasone should only be a viable option in a research setting.
多项随机对照试验表明，在择期足月剖宫产术前肌内（IM）注射地塞米松可降低新生儿短暂性呼吸急促的发生率和新生儿入住新生儿重症监护病房（NICU）的比例。最近的研究表明，完整疗程的 IM 类固醇可能会对婴儿出生后产生长期的有害后果，并且有研究表明，较低剂量的 IM 皮质类固醇可能有益。因此，我们旨在确定将地塞米松剂量减半至 12mg 是否可以在最小化胎儿暴露的情况下，为择期足月剖宫产带来任何益处。
我们在产科和妇科中心进行了一项观察性对照研究，比较了单次 12mg 地塞米松给药前后的新生儿呼吸并发症，以评估其在择期足月剖宫产中的应用。我们纳入了在 37+0 至 38+6 周进行择期剖宫产的单胎妊娠患者。共有 674 名患者符合纳入标准并被招募。我们比较了在没有 IM 地塞米松注射的情况下，2019 年上半年的新生儿入住 NICU 的比例和时间、需要机械通气的比例和新生儿短暂性呼吸急促的发生率，与下半年使用 IM 地塞米松单次给药时进行比较。
IM 地塞米松注射并没有显示出在降低新生儿入住 NICU（比值比 0.97，p 值 0.69）、入住 NICU（比值比 0.91，p 值 0.80）、需要机械通气（比值比 0.98，p 值 0.95）和新生儿短暂性呼吸急促（比值比 1.01，p 值 0.96）方面的显著获益。两组新生儿在 NICU 中的入住时间也没有显著差异（p 值 0.17）。
本研究表明，对于择期足月剖宫产，低剂量产前皮质类固醇并没有带来显著的获益，而且已经有研究表明，足月时使用高剂量产前皮质类固醇会产生长期的有害后果，因此，在进行更大规模的研究来反驳这些发现之前，应停止这种做法。这种地塞米松的使用应仅作为研究的可行选择。
