Chawla Sanjay, Wyckoff Myra H, Lakshminrusimha Satyan, Rysavy Matthew A, Patel Ravi Mangal, Chowdhury Dhuly, Das Abhik, Greenberg Rachel G, Natarajan Girija, Shankaran Seetha, Bell Edward F, Ambalavanan Namasivayam, Younge Noelle E, Laptook Abbot R, Pavlek Leeann R, Backes Carl H, Van Meurs Krisa P, Werner Erika F, Carlo Waldemar A
Department of Pediatrics, Central Michigan University, Wayne State University, Children's Hospital of Michigan, Detroit, Michigan.
Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas.
JAMA Netw Open. 2025 Feb 3;8(2):e2461312. doi: 10.1001/jamanetworkopen.2024.61312.
When preterm delivery is imminent, it remains unclear whether the timing from administration of antenatal betamethasone to birth may reduce mortality and morbidity among extremely preterm infants.
To evaluate the association of duration from exposure to first dose of antenatal betamethasone with outcomes among extremely preterm infants.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study enrolled infants born at 22 0/7 to 27 6/7 weeks' gestation from January 2016 to February 2021 at National Institute of Child Health and Human Development Neonatal Research Network centers. Infants exposed to multiple doses of antenatal betamethasone, infants who did not receive intensive care, and infants with congenital anomalies were excluded. Data were analyzed from October 2021 to December 2024.
Time in hours from anenatal betamethasone administration to birth.
The primary outcome was survival to discharge. Secondary outcomes included survival without major morbidity and composites of individual morbidities and death. The association of time from antenatal betamethasone administration to birth with neonatal survival and morbidity was assessed using generalized linear models, adjusting for gestational age, infant sex, maternal race, education, small for gestational age, mode of delivery, multiple birth, prolonged rupture of membranes, and center of birth.
Of 7464 infants born during the study period, 1806 infants (928 [51.3%] boys) were included in the cohort: 475 with no betamethasone and 1331 with exposure to a single dose of betamethasone within 24 hours before birth. The median (IQR) administration-to-birth interval for infants born after a single dose of betamethasone was 3.8 (1.4-9.5) hours. The administration-to-birth interval was independently associated with survival (adjusted relative risk [aRR] per 1-hour increase, 1.01 [95% CI, 1.00-1.01]; aRR per 6-hour increase, 1.04 [95% CI, 1.01-1.07]) and survival without severe neonatal morbidity (aRR per 1-hour increase, 1.01 [95% CI, 1.01-1.02]; aRR per 6-hour increase, 1.09 [95% CI, 1.04-1.14].
In this cohort study, for women at risk of imminent preterm birth, even short duration of exposure to antenatal betamethasone was associated with improved neonatal survival and survival without severe neonatal morbidity.
当早产即将发生时，产前倍他米松给药至出生的时间是否可降低极早产儿的死亡率和发病率仍不明确。
评估从暴露于首剂产前倍他米松开始计时的时长与极早产儿结局之间的关联。
设计、设置和参与者：这项队列研究纳入了2016年1月至2021年2月在国家儿童健康与人类发展研究所新生儿研究网络中心出生、孕周为22⁰/₇至27⁶/₇周的婴儿。排除接受多剂产前倍他米松治疗的婴儿、未接受重症监护的婴儿以及患有先天性异常的婴儿。于2021年10月至2024年12月进行数据分析。
从产前倍他米松给药至出生的小时数。
主要结局为存活至出院。次要结局包括无重大疾病存活以及个体疾病和死亡的综合情况。使用广义线性模型评估从产前倍他米松给药至出生的时间与新生儿存活及发病情况之间的关联，并对孕周、婴儿性别、母亲种族、教育程度、小于胎龄、分娩方式、多胎妊娠、胎膜早破时间延长以及出生中心进行校正。
在研究期间出生的7464名婴儿中，1806名婴儿（928名[51.3%]为男婴）被纳入队列：475名未使用倍他米松，1331名在出生前24小时内暴露于单剂倍他米松。单剂倍他米松治疗后出生的婴儿，给药至出生间隔的中位数（IQR）为3.8（1.4 - 9.5）小时。给药至出生间隔与存活（每增加1小时，校正相对风险[aRR]为1.01[95%CI，1.00 - 1.01]；每增加6小时，aRR为1.04[95%CI，1.01 - 1.07]）以及无严重新生儿疾病存活（每增加1小时，aRR为1.01[95%CI，1.01 - 1.02]；每增加6小时，aRR为1.09[95%CI，1.04 - 1.14]）独立相关。
在这项队列研究中，对于有早产风险的女性，即使短时间暴露于产前倍他米松也与新生儿存活率提高以及无严重新生儿疾病存活相关。
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