Samouilidis Alexandros, Beltsios Eleftherios T, Mavrovounis Georgios, Adamou Antonis, Belios Ioannis, Hadjivasilis Alexandros, Pantazopoulos Ioannis, Agouridis Aris P
Internal Medicine, European University Cyprus, Nicosia, CYP.
Emergency Medicine, University of Thessaly, Larissa, GRC.
Cureus. 2022 Aug 10;14(8):e27865. doi: 10.7759/cureus.27865. eCollection 2022 Aug.
There are no acceptable worldwide recommendations regarding the use of dexamethasone in late-preterm newborns delivered either vaginally or via cesarean section and term gestation that are performed via cesarean section. The present study aims to compare the effectiveness of antenatal intramuscular dexamethasone versus placebo/no-treatment in reducing neonatal respiratory complications in high-risk for imminent preterm birth in late preterm pregnancies and term pregnancies undergoing elective cesarean section. The PubMed, Scopus, and Cochrane Library databases were searched to assess the effectiveness of dexamethasone during late preterm and term gestation. The last literature search was performed on March 20th, 2022. Randomized controlled trials compared antenatal dexamethasone administration with placebo or no treatment. The outcomes of interest were: the incidence of Respiratory Distress Syndrome; Transient Tachypnea of the Newborn, Neonatal Intensive Care Unit admissions; and the need for ventilatory support or mechanical ventilation. A standardized data form and three independent investigators performed the data extraction. Ten RCTs fulfilled our inclusion criteria. No statistically significant difference was found regarding all of the outcomes in the 34th-36th gestational week group. In the >37th gestational week group, a statistically significant difference was found regarding the incidence of RDS [RR (95% CI); p-value: 0.56 (0.36, 0.87); 0.01], TTN [RR (95% CI); p-value: 0.54 (0.42, 0.71); <0.00001], need for ventilatory support [RR (95% CI); p-value: 0.71 (0.52, 0.96); 0.03] and need for mechanical ventilation [RR (95% CI); p-value: 0.56 (0.33, 0.95); 0.03]. To conclude, the antenatal administration of dexamethasone can be considered to prevent neonatal complications and reduce perinatal morbidity in term pregnancies.
对于经阴道分娩或剖宫产的晚期早产儿以及剖宫产的足月儿使用地塞米松，目前尚无全球公认的建议。本研究旨在比较产前肌肉注射地塞米松与安慰剂/不治疗在降低晚期早产高危且行择期剖宫产的晚期早产和足月妊娠新生儿呼吸并发症方面的有效性。检索了PubMed、Scopus和Cochrane图书馆数据库，以评估地塞米松在晚期早产和足月妊娠期间的有效性。最后一次文献检索于2022年3月20日进行。随机对照试验比较了产前给予地塞米松与安慰剂或不治疗的情况。感兴趣的结局包括：呼吸窘迫综合征的发生率；新生儿短暂性呼吸急促、新生儿重症监护病房入院情况；以及通气支持或机械通气的需求。采用标准化数据表格，由三名独立研究人员进行数据提取。十项随机对照试验符合我们的纳入标准。在孕34 - 36周组中，所有结局均未发现统计学显著差异。在孕>37周组中，发现呼吸窘迫综合征的发生率[相对危险度（95%置信区间）；p值：0.56（0.36，0.87）；0.01]、新生儿短暂性呼吸急促[相对危险度（95%置信区间）；p值：0.54（0.42，0.71）；<0.00001]、通气支持需求[相对危险度（95%置信区间）；p值：0.71（0.52，0.96）；0.03]和机械通气需求[相对危险度（95%置信区间）；p值：0.56（0.33，0.95）；0.03]存在统计学显著差异。总之，可考虑产前给予地塞米松以预防足月妊娠新生儿并发症并降低围产期发病率。
