Department of Pediatrics, Division of Neonatology and Perinatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Am J Perinatol. 2024 Mar;41(4):478-487. doi: 10.1055/a-1695-8220. Epub 2021 Nov 12.
Before the advent of antenatal steroids, early non-invasive respiratory support (NIV), and intratracheal surfactant, antenatal terbutaline was also used to improve lung compliance and reduce the incidence of respiratory distress syndrome (RDS).
The objective of this paper was to study the association between antenatal terbutaline and endotracheal intubation (ET) within the first 24 hours of life, RDS, bronchopulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) in infants with the gestational age (GA) of <32 weeks, and to study the association between antenatal terbutaline, and ET or NIV within the first 24 hours of life, and RDS in infants with the GA of 32 to 36 weeks.
This was a retrospective medical record review of preterm infants delivered at a single tertiary care center from October 2016 to December 2020. Multivariable logistic regression was used to explore the association between antenatal terbutaline and neonatal respiratory support.
1,794 infants were included, 234 (13.0%) had the GA of <32 weeks and 1,560 (86.9%) had the GA of 32 to 36 weeks. Antenatal terbutaline, corticosteroid, or both agents were administered in 561 (31.3%), 1,461 (81.4%), and 555 (30.9%), respectively. Antenatal terbutaline was significantly associated with a reduction in ET (adjusted odds ratio [aOR] = 0.40, 95% confident interval [CI] 0.19-0.82, = 0.012) in infants with the GA of <32 weeks, but not in infants with the GA of 32-36 weeks. Antenatal terbutaline was not associated with RDS or BPD but was significantly associated with a reduction in grade III-IV IVH (aOR 0.11, CI 0.01-0.98; = 0.048), in infants with the GA of <32 weeks.
In a state-of-the-art neonatal care setting, antenatal terbutaline was associated with a reduction in ET during the first 24 hours in infants with the GA of <32 weeks. The use of antenatal terbutaline to improve acute neonatal respiratory outcomes merits reconsideration.
· The neonatal respiratory benefits of antenatal terbutaline in the era of antenatal corticosteroids were uncertain.. · Terbutaline is associated with a reduction in endotracheal intubation in a modern care setting.. · The role of terbutaline, and potentially other betamimetics, to improve neonatal respiratory outcomes merits reconsideration..
在产前类固醇、早期非侵入性呼吸支持（NIV）和气管内表面活性剂出现之前，产前特布他林也被用于改善肺顺应性并降低呼吸窘迫综合征（RDS）的发生率。
本文旨在研究产前特布他林与<32 周胎龄婴儿出生后 24 小时内气管内插管（ET）、RDS、支气管肺发育不良（BPD）和脑室出血（IVH）之间的关系，并研究产前特布他林与 32 至 36 周胎龄婴儿出生后 24 小时内 ET 或 NIV 之间的关系与 RDS 之间的关系。
这是对 2016 年 10 月至 2020 年 12 月在一家三级保健中心分娩的早产儿进行的回顾性病历回顾。使用多变量逻辑回归来探讨产前特布他林与新生儿呼吸支持之间的关系。
共纳入 1794 名婴儿，其中<32 周胎龄的有 234 名（13.0%），32-36 周胎龄的有 1560 名（86.9%）。产前特布他林、皮质类固醇或两者分别在 561 名（31.3%）、1461 名（81.4%）和 555 名（30.9%）婴儿中使用。产前特布他林与<32 周胎龄婴儿 ET 的减少显著相关（调整后的优势比[aOR] = 0.40，95%置信区间[CI] 0.19-0.82， = 0.012），但与 32-36 周胎龄婴儿的 ET 减少无关。产前特布他林与 RDS 或 BPD 无关，但与<32 周胎龄婴儿的 III-IV 级 IVH 减少显著相关（aOR 0.11，CI 0.01-0.98； = 0.048）。
在现代新生儿护理环境中，产前特布他林与<32 周胎龄婴儿出生后 24 小时内 ET 的减少相关。使用产前特布他林改善急性新生儿呼吸结局值得重新考虑。
·产前类固醇时代产前特布他林对新生儿呼吸的益处尚不确定。·特布他林与现代护理环境中气管内插管的减少有关。·特布他林和潜在的其他β激动剂改善新生儿呼吸结局的作用值得重新考虑。
