Xodo Serena, Trombetta Giulia, Celante Lisa, Pittini Carla, Driul Lorenza, Cagnacci Angelo, Londero Ambrogio P
Department of Gynecology and Obstetrics, School of Medicine of Udine, Udine, Italy.
Unit of Neonatology, University Hospital of Udine, Udine, Italy.
Front Pediatr. 2022 Aug 15;10:894526. doi: 10.3389/fped.2022.894526. eCollection 2022.
This study aimed to compare the outcomes of preterm infants given 12 vs. 24mg of betamethasone prophylaxis to understand whether a partial course of antenatal corticosteroids (CCS) could prevent or mitigate the major preterm birth complications.
This is a retrospective single-center cohort study including neonates born between 24 and 34 weeks of gestation from 2001 to 2019 at the University Hospital of Udine. The study population was divided into two groups: one group received 12mg, and another received a 24mg dose of betamethasone before the delivery. A separate analysis was performed for single and multiple pregnancies. The two groups were evaluated for various neonatal outcomes.
The study population included a total of 1,258 pregnancies and 1,543 neonates delivered between 24 and 34 weeks of gestation, of which 1,022 (803 single and 219 multiple pregnancies) were exposed to the complete CCS prophylaxis, whereas 236 (192 single and 44 multiple pregnancies) received the incomplete CCS prophylaxis. In single pregnancies, as for maternal characteristics, the most significant differences observed between the two groups are the following: a higher prevalence of spontaneous vaginal deliveries in the incomplete CCS prophylaxis (36.46 vs. 23.91%) and, by contrast, a higher prevalence of cesarean deliveries in the complete CCS prophylaxis group (75.72 vs. 63.02%). As for neonatal outcomes, the low Apgar score in the first and fifth min was significantly more prevalent in the incomplete CCS prophylaxis group compared with the complete CCS prophylaxis group. The group of incomplete CCS prophylaxis reported a higher occurrence of the following outcomes: IVH grade 3-4 (7.81 vs. 3.74%, < 0.05), PVL (7.29 vs. 1.99% < 0.05), ROP (23.96 vs. 18.06% = 0.062), and RDS (84.38 vs. 78.83% = 0.085). After adjusting for covariates, the complete CCS prophylaxis group in single pregnancies was significantly protective for IVH grade 3-4, PVL, and low Apgar's scores. Similar results were found in multiple pregnancies except for RDS.
This retrospective single-center cohort study found that, compared with preterm infants treated with 24mg betamethasone , those given half course of betamethasone had a significantly higher prevalence of IVH grade 3-4, PVL, RDS, and lower Apgar scores at 1 and 5 min. In conclusion, the evidence from this single-center retrospective study supports the preference for the complete CCS prophylaxis in women at risk of preterm birth because of its beneficial effect on the main adverse outcomes.
本研究旨在比较接受12毫克与24毫克倍他米松预防治疗的早产儿的结局，以了解产前皮质类固醇激素（CCS）的部分疗程是否可以预防或减轻主要的早产并发症。
这是一项回顾性单中心队列研究，纳入了2001年至2019年在乌迪内大学医院出生的妊娠24至34周的新生儿。研究人群分为两组：一组接受12毫克，另一组在分娩前接受24毫克倍他米松治疗。对单胎和多胎妊娠分别进行分析。对两组的各种新生儿结局进行评估。
研究人群包括总共1258例妊娠和1543例妊娠24至34周分娩的新生儿，其中1022例（803例单胎和219例多胎妊娠）接受了完整的CCS预防治疗，而236例（192例单胎和44例多胎妊娠）接受了不完整的CCS预防治疗。在单胎妊娠中，就母体特征而言，两组之间观察到的最显著差异如下：不完整CCS预防组中自然阴道分娩的患病率较高（36.46%对23.91%），相比之下，完整CCS预防组中剖宫产的患病率较高（75.72%对63.02%）。就新生儿结局而言，与完整CCS预防组相比，不完整CCS预防组中第1分钟和第5分钟低Apgar评分的情况明显更普遍。不完整CCS预防组报告以下结局的发生率较高：3-4级脑室内出血（7.81%对3.74%，P<0.05）、脑室周围白质软化（7.29%对1.99%，P<0.05）、视网膜病变（23.96%对18.06%，P=0.062）和呼吸窘迫综合征（84.38%对78.83%，P=0.085）。在对协变量进行调整后，单胎妊娠中的完整CCS预防组对3-4级脑室内出血、脑室周围白质软化和低Apgar评分具有显著的保护作用。在多胎妊娠中除呼吸窘迫综合征外也发现了类似结果。
这项回顾性单中心队列研究发现，与接受24毫克倍他米松治疗的早产儿相比，接受半疗程倍他米松治疗的早产儿中3-4级脑室内出血、脑室周围白质软化、呼吸窘迫综合征的患病率显著更高，且在第1分钟和第5分钟时Apgar评分更低。总之，这项单中心回顾性研究的证据支持对有早产风险的女性优先采用完整的CCS预防治疗，因为其对主要不良结局具有有益作用。
