Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
Division of Reproduction and Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan.
BMC Pregnancy Childbirth. 2024 Sep 18;24(1):607. doi: 10.1186/s12884-024-06790-8.
Antenatal corticosteroids (ACS) are administered to prevent neonatal complications and death in women at risk of imminent preterm birth. Internationally, the optimal interval from ACS to delivery (ACS-to-delivery interval) is within seven days; however, evidence in Asian populations specifically is limited. This study aimed to investigate the association between ACS-to-delivery interval and the incidence of neonatal complications in Japan.
This retrospective observational study enrolled singleton neonates born preterm at < 32 weeks of gestational age between 2012 and 2020 at two tertiary centers. A total of 625 neonates were divided into the following four groups according to the timing of ACS (measured in days): no ACS (n = 145), partial ACS (n = 85), ACS 1-7 (n = 307), and ACS ≥ 8 (n = 88). The following outcomes were compared between the groups: treated respiratory distress syndrome (RDS), severe intraventricular hemorrhage (IVH), treated patent ductus arteriosus (PDA), necrotizing enterocolitis, sepsis, bronchopulmonary dysplasia (BPD), treated retinopathy of prematurity (ROP), periventricular leukomalacia, and death discharge.
The ACS 1-7 group had significantly decreased adjusted odds ratios (ORs) for treated RDS (0.37 [95% confidence interval: 0.23, 0.57]), severe IVH (0.21 [0.07, 0.63]), treated PDA (0.47 [0.29, 0.75]), and treated ROP (0.50 [0.25, 0.99]) compared with the no ACS group. The ACS ≥ 8 group also showed significantly reduced adjusted ORs for RDS (0.37 [0.20, 0.66]) and treated PDA (0.48 [0.25, 0.91]) compared with the no ACS group. However, the adjusted ORs for BPD significantly increased in both the ACS 1-7 (1.86 [1.06, 3.28]) and ACS ≥ 8 groups (2.94 [1.43, 6.05]) compared to the no ACS group.
An ACS-to-delivery interval of 1-7 days achieved the lowest incidence of several complications in preterm neonates born at < 32 weeks of gestational age. Some of the favorable effects of ACS seem to continue even beyond ≥ 8 days from administration. In contrast, ACS might be associated with an increased incidence of BPD, which was most likely to be prominent in neonates delivered ≥ 8 days after receiving ACS. Based on these findings, the duration of the effect of ACS on neonatal complications should be studied further.
产前皮质激素（ACS）用于预防有早产风险的妇女的新生儿并发症和死亡。在国际上，ACS 到分娩的最佳间隔时间（ACS 到分娩间隔时间）在七天内；然而，具体在亚洲人群中的证据有限。本研究旨在探讨 ACS 到分娩的间隔时间与日本新生儿并发症发生率之间的关系。
这项回顾性观察性研究纳入了 2012 年至 2020 年在两家三级中心出生的胎龄<32 周的早产儿单胎新生儿。共有 625 名新生儿根据 ACS 的时间（以天为单位）分为以下四组：无 ACS（n=145）、部分 ACS（n=85）、ACS 1-7（n=307）和 ACS≥8（n=88）。比较各组之间的以下结局：治疗性呼吸窘迫综合征（RDS）、严重脑室内出血（IVH）、治疗性动脉导管未闭（PDA）、坏死性小肠结肠炎、败血症、支气管肺发育不良（BPD）、治疗性早产儿视网膜病变（ROP）、脑室周围白质软化和死亡出院。
ACS 1-7 组治疗性 RDS（0.37 [95%置信区间：0.23, 0.57]）、严重 IVH（0.21 [0.07, 0.63]）、治疗性 PDA（0.47 [0.29, 0.75]）和治疗性 ROP（0.50 [0.25, 0.99]）的调整后优势比（OR）显著降低与无 ACS 组相比。ACS≥8 组与无 ACS 组相比，RDS（0.37 [0.20, 0.66]）和治疗性 PDA（0.48 [0.25, 0.91]）的调整后 OR 也显著降低。然而，ACS 1-7 组（1.86 [1.06, 3.28]）和 ACS≥8 组（2.94 [1.43, 6.05]）的调整后 OR 均显著增加，与无 ACS 组相比，BPD 的发生率显著增加。
ACS 到分娩的间隔时间为 1-7 天可使胎龄<32 周的早产儿发生的几种并发症的发生率达到最低。ACS 的一些有利影响似乎甚至在给药后≥8 天仍在继续。相比之下，ACS 可能与 BPD 的发生率增加有关，在接受 ACS 治疗后≥8 天分娩的新生儿中，BPD 的发生率很可能最为显著。基于这些发现，应进一步研究 ACS 对新生儿并发症的影响持续时间。
