Bashir Humayra Aisha, Lufting-Leeffrers Daphne, Myat Min Aung, Htun Win Htun, Win Tun Nay, Gay Wah Tha, Ellen Gilder Mary, Kho Paw Moo, I Carrara Verena, Meeyai Aronrag, Aderoba Adeniyi Kolade, Nosten François, Gross Mechthild M, McGready Rose
Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, Thailand.
Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, England, UK.
Wellcome Open Res. 2024 Mar 14;8:225. doi: 10.12688/wellcomeopenres.19396.2. eCollection 2023.
Prematurity is the highest risk for under-five mortality globally. The aim of the study was to assess the effect of antenatal dexamethasone on neonatal mortality in early preterm in a resource-constrained setting without assisted ventilation.
This retrospective (2008-2013) cohort study in clinics for refugees/migrants on the Thai-Myanmar border included infants born <34 weeks gestation at home, in, or on the way to the clinic. Dexamethasone, 24 mg (three 8 mg intramuscular doses, every 8 hours), was prescribed to women at risk of preterm birth (28 to <34 weeks). Appropriate newborn care was available: including oxygen but not assisted ventilation. Mortality and maternal fever were compared by the number of doses (complete: three, incomplete (one or two), or no dose). A sub-cohort participated in neurodevelopmental testing at one year.
Of 15,285 singleton births, 240 were included: 96 did not receive dexamethasone and 144 received one, two or three doses (56, 13 and 75, respectively). Of live-born infants followed to day 28, (n=168), early neonatal and neonatal mortality/1,000 livebirths (95%CI) with complete dosing was 217 (121-358) and 304 (190-449); compared to 394 (289-511) and 521 (407-633) with no dose. Compared to complete dosing, both incomplete and no dexamethasone were associated with elevated adjusted ORs 4.09 (1.39 to 12.00) and 3.13 (1.14 to 8.63), for early neonatal death. By contrast, for neonatal death, while there was clear evidence that no dosing was associated with higher mortality, adjusted OR 3.82 (1.42 to 10.27), the benefit of incomplete dosing was uncertain adjusted OR 1.75 (0.63 to 4.81). No adverse impact of dexamethasone on infant neurodevelopmental scores (12 months) or maternal fever was observed.
Neonatal mortality reduction is possible with complete dexamethasone dosing in pregnancies at risk of preterm birth in settings without capacity to provide assisted ventilation.
早产是全球五岁以下儿童死亡的最高风险因素。本研究的目的是评估在没有辅助通气的资源受限环境中，产前地塞米松对极早早产儿新生儿死亡率的影响。
这项在泰缅边境难民/移民诊所进行的回顾性队列研究（2008 - 2013年）纳入了在家中、诊所内或前往诊所途中出生的孕周小于34周的婴儿。对于有早产风险（28至小于34周）的妇女，给予24毫克地塞米松（每8小时肌肉注射3次，每次8毫克）。可提供适当的新生儿护理：包括氧气，但不包括辅助通气。根据给药剂量（完整：三次；不完整（一次或两次）；或未给药）比较死亡率和产妇发热情况。一个亚队列在一岁时参加了神经发育测试。
在15,285例单胎分娩中，240例被纳入研究：96例未接受地塞米松治疗，144例接受了一、二或三次剂量治疗（分别为56例、13例和75例）。在随访至28天的活产婴儿中（n = 168），完整给药组每1000例活产儿的早期新生儿和新生儿死亡率（95%CI）分别为217（121 - 358）和304（190 - 449）；未给药组分别为394（289 - 511）和521（407 - 633）。与完整给药相比，不完整给药和未使用地塞米松均与早期新生儿死亡的调整后OR值升高相关，分别为4.09（1.39至12.00）和3.13（1.14至8.63）。相比之下，对于新生儿死亡，虽然有明确证据表明未给药与较高死亡率相关，调整后OR为3.82（1.42至10.27），但不完整给药的益处不确定，调整后OR为1.75（0.63至4.81）。未观察到地塞米松对婴儿神经发育评分（12个月）或产妇发热有不良影响。
在没有能力提供辅助通气的环境中，对有早产风险的孕妇进行完整剂量的地塞米松给药可降低新生儿死亡率。
