Department of Neonatology, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China.
J Healthc Eng. 2022 Mar 7;2022:2310080. doi: 10.1155/2022/2310080. eCollection 2022.
Administration of antenatal corticosteroids (ACSs) is an effective strategy for managing preterm infants, which improves neonatal respiratory distress syndrome (NRDS) and attenuates the risk of neonatal mortality. However, many preterm infants are not exposed to a complete course of ACS administration, and the effects of different ACS-to-delivery intervals on NRDS and respiratory support remain unclear. Therefore, this study explored the relationship between ACS-to-birth intervals and NRDS and respiratory support in preterm infants.
In this retrospective cohort study, the preterm infants born between 240/7 and 316/7 wks of gestation were recruited from January 2015 to July 2021. All participants were categorised based on the time interval from the first ACS dose to delivery: <24 h, 1-2 d, 2-7 d, and >7 d. Multivariable logistic regression analysis examined the relationships between the ACS-to-birth interval and primary or secondary outcome while adjusting for potential confounders.
Of the 706 eligible neonates, 264, 83, 292, and 67 received ACS-to-delivery intervals of <24 h, 1-2 d, 2-7 d, and >7 d, respectively. After adjusting these confounding factors, the multivariable logistic analysis showed a significantly increased risk of NRDS (aOR: 1.8, 95% CI: 1.2-2.7), neonatal mortality (aOR: 2.8, 95% CI: 1.1-6.8), the need for surfactant use (aOR: 2.7, 95% CI: 1.7-4.4), endotracheal intubation in the delivery room (aOR: 1.9, 95% CI: 1.0-3.7), and mechanical ventilation (aOR: 1.9, 95% CI: 1.1-3.4) in the ACS-to-delivery interval of <24 h group when compared with the ACS-to-birth interval of 2-7 d group.
Neonatal outcomes such as NRDS, neonatal mortality, the need for surfactant use, intubation in the delivery room, and the risk of mechanical ventilation are higher when the neonates are exposed to an ACS interval for less than 24 h before delivery.
产前使用皮质类固醇（ACS）是管理早产儿的有效策略，可改善新生儿呼吸窘迫综合征（NRDS）并降低新生儿死亡率。然而，许多早产儿并未接受完整疗程的 ACS 治疗，不同 ACS 至分娩间隔对 NRDS 和呼吸支持的影响尚不清楚。因此，本研究探讨了 ACS 至分娩间隔与早产儿 NRDS 和呼吸支持的关系。
本回顾性队列研究纳入了 2015 年 1 月至 2021 年 7 月期间胎龄 240/7 至 316/7 周的早产儿。所有参与者均根据从第一剂 ACS 到分娩的时间间隔进行分类：<24 小时、1-2 天、2-7 天和>7 天。多变量逻辑回归分析调整潜在混杂因素后，考察了 ACS 至分娩间隔与主要或次要结局之间的关系。
在 706 名符合条件的新生儿中，分别有 264、83、292 和 67 名新生儿接受 ACS 至分娩的间隔时间为<24 小时、1-2 天、2-7 天和>7 天。调整这些混杂因素后，多变量逻辑分析显示 NRDS（aOR：1.8，95%CI：1.2-2.7）、新生儿死亡率（aOR：2.8，95%CI：1.1-6.8）、需要使用表面活性剂（aOR：2.7，95%CI：1.7-4.4）、产房内气管插管（aOR：1.9，95%CI：1.0-3.7）和机械通气（aOR：1.9，95%CI：1.1-3.4）的风险显著增加在 ACS 至分娩间隔<24 小时组与 ACS 至分娩间隔 2-7 天组相比。
与 ACS 至分娩间隔 2-7 天组相比，新生儿在分娩前接受 ACS 治疗的时间间隔<24 小时时，NRDS、新生儿死亡率、需要使用表面活性剂、产房内插管和机械通气的风险更高。
