School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania.
Muhimbili National Hospital, P.O. Box 65000, Dar Es Salaam, Tanzania.
BMC Pediatr. 2023 Mar 1;23(1):94. doi: 10.1186/s12887-023-03887-5.
Respiratory distress syndrome (RDS) is a significant cause of preterm neonatal morbidity and mortality globally. Measures like the use of antenatal corticosteroids (ACS) and immediate resuscitation of the newborn after birth are taken to abate preterm related complications. Most studies that evidenced the benefit of ACS were done in high resource settings. Therefore, this study was conducted to assess the effectiveness of ACS in reducing RDS and neonatal mortality in preterm neonates in resource-limited settings.
A three months prospective nested case-control study (1:2 unmatched) was conducted at Muhimbili National Hospital and Amana regional referral hospital in Dar es salaam, Tanzania. Neonates delivered at 28 to 34 gestational weeks were enrolled and followed up until discharge. Data analysis was done using the statistical package of social sciences version 23. Logistic regression analysis was used to determine the effect of ACS on the RDS and mortality in the cohort, controlling for important maternal and neonatal variables. All tests were considered statistically significant at p < 0.05.
Out of 330 preterm neonates enrolled, 110 were cases and 220 were controls. The median gestational age at delivery was 30 weeks and 6 days (IQR 4.68) among cases and 33 weeks (IQR 3) among controls. One-minute APGAR score of < 7 (AOR: 3.11; 95% CI 1.54-6.30), and neonatal birth weight (AOR: 0.998; 95% CI 0.997-0.999) were significantly associated with RDS. No significant association was observed between ACS exposure and RDS occurrence (AOR: 1.65; 95% CI 0.86 - 3.15). The overall mortality rate was 9 per 1000 neonates. Neonatal mortality occurred only among cases whereby, a unit increase in gestational age was associated with a 30% reduction in neonatal mortality (Adjusted hazard ratio, AHR: 0.70, 95% CI: 0.5-0.92, p = 0.011).
Decrease in gestational age, one minute APGAR score of < 7 and decreasing birth weight were associated with RDS among preterm neonates. ACS was not associated with reduced RDS occurrence and neonatal mortality rates. Moreover, increase in gestation age was the only factor found to be protective against preterm neonatal mortality.
呼吸窘迫综合征（RDS）是全球导致早产儿发病率和死亡率的重要原因。为了减轻与早产相关的并发症，会采取使用产前皮质类固醇（ACS）和新生儿出生后立即复苏等措施。大多数证明 ACS 有益的研究都是在资源丰富的环境中进行的。因此，本研究旨在评估 ACS 在资源有限环境中降低早产儿 RDS 和新生儿死亡率的效果。
在坦桑尼亚达累斯萨拉姆的穆希比利国家医院和阿曼那地区转诊医院进行了为期三个月的前瞻性嵌套病例对照研究（1:2 不匹配）。纳入了在 28 至 34 孕周分娩的新生儿，并对其进行随访直至出院。数据分析使用社会科学统计软件包 23 版进行。使用逻辑回归分析来确定 ACS 对队列中 RDS 和死亡率的影响，同时控制了重要的母婴和新生儿变量。所有检验均以 p<0.05 为统计学显著。
在纳入的 330 名早产儿中，110 名是病例，220 名是对照。分娩时的中位胎龄为 30 周零 6 天（IQR 4.68），病例组为 33 周（IQR 3）。1 分钟 Apgar 评分<7（OR：3.11；95%CI 1.54-6.30）和新生儿出生体重（OR：0.998；95%CI 0.997-0.999）与 RDS 显著相关。ACS 暴露与 RDS 发生之间无显著相关性（OR：1.65；95%CI 0.86-3.15）。总体死亡率为每 1000 名新生儿 9 例。新生儿死亡仅发生在病例组，胎龄每增加 1 个单位，新生儿死亡率降低 30%（调整后的危险比，AHR：0.70，95%CI：0.5-0.92，p=0.011）。
在早产儿中，胎龄下降、1 分钟 Apgar 评分<7 和出生体重下降与 RDS 相关。ACS 与降低 RDS 发生率和新生儿死亡率无关。此外，发现胎龄增加是唯一对早产儿死亡有保护作用的因素。
