足月儿的产前皮质类固醇暴露与新生儿结局

Antenatal corticosteroid exposure and neonatal outcomes in term infants.

作者信息

Chung Hao-Wei, Yu Chia-Hung, Huang Chiao-Yun, Liang Fu-Wen

机构信息

Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shiquan 1st Rd., Sanmin Dist., Kaohsiung City 807378, Taiwan; Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Shiquan 1st Rd., Sanmin Dist., Kaohsiung City 807378, Taiwan; Department of Biological Science and Technology, National Yang Ming Chiao Tung University, No. 75 Po-Ai Street, Hsinchu 300, Taiwan; Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, No. 482, Shanming Rd., Siaogang Dist., Kaohsiung City 812, Taiwan; Center for Big Data Research, Kaohsiung Medical University, No. 100, Shiquan 1st Rd., Sanmin Dist., Kaohsiung City 807378, Taiwan.

Department of Anesthesiology, Chi Mei Medical Center, No.901, Zhonghua Rd., Yongkang Dist., Tainan City 71004, Taiwan; Department of Computer Science and Information Engineering, Southern Taiwan University of Science and Technology, No.1, Nantai St., Yungkang Dist., Tainan City 710301, Taiwan.

出版信息

Early Hum Dev. 2025 Sep;208:106325. doi: 10.1016/j.earlhumdev.2025.106325. Epub 2025 Jun 20.

DOI:10.1016/j.earlhumdev.2025.106325

PMID:40570607

Abstract

BACKGROUND

Antenatal corticosteroids (ACS) are widely used to mitigate respiratory distress in preterm infants. Although the benefits of ACS in preterm births are well established, less is known about the short-term neonatal risks when ACS is administered during pregnancies that result in term delivery. Additionally, the impact of gestational age at the time of ACS exposure in this population remains unclear.

AIM

To evaluate the association between ACS exposure and short-term neonatal outcomes in term-born singleton infants, and further assess outcome variation by gestational age at exposure.

METHOD

This retrospective, population-based cohort study used data from the Taiwan Maternal and Child Health Database and the National Health Insurance Research Database to compare term-born singleton infants exposed to ACS for threatened preterm labor with those unexposed, whose mothers had no diagnosis of preterm labor and no recorded ACS administration. Neonatal outcomes were analyzed using multivariable logistic regression.

RESULTS

Among 800,024 term births, 5577 (0.6 %) were exposed to ACS due to preterm labor. ACS-exposed infants had higher rates of SGA, CPAP, oxygen use, NICU admission, sepsis, hypoglycemia, TTNB, and jaundice (P < 0.001). Adjusted analyses revealed higher odds of SGA (aOR 1.30; 95 % CI 1.20-1.41), NICU admission (aOR 1.16; 95 % CI 0.99-1.36), and hyperbilirubinemia (aOR 1.49; 95 % CI 1.38-1.61) in the exposed group. Exposure between 28 and 33 weeks was associated with increased odds of oxygen therapy (aOR 1.42; 95 % CI 1.21-1.67) and TTNB (aOR 1.40; 95 % CI 1.00-1.94).

CONCLUSION

ACS exposure is associated with increased risks of short-term neonatal complications among term-born infants, especially when exposure between 28 and 33 weeks' gestation. Even when pregnancies end in term delivery, ACS exposure may still increase neonatal morbidity risk.

摘要

背景

产前使用糖皮质激素（ACS）广泛用于减轻早产儿的呼吸窘迫。虽然ACS在早产中的益处已得到充分证实，但对于在导致足月分娩的妊娠期间使用ACS时新生儿的短期风险了解较少。此外，在该人群中，暴露于ACS时的胎龄影响仍不明确。

目的

评估足月单胎婴儿暴露于ACS与短期新生儿结局之间的关联，并进一步评估暴露时胎龄对结局的差异影响。

方法

这项基于人群的回顾性队列研究使用了台湾妇幼健康数据库和国民健康保险研究数据库的数据，比较因先兆早产而暴露于ACS的足月单胎婴儿与未暴露的婴儿，后者的母亲未诊断为先兆早产且未记录使用ACS。使用多变量逻辑回归分析新生儿结局。

结果

在800,024例足月分娩中，5577例（0.6%）因早产而暴露于ACS。暴露于ACS的婴儿发生小于胎龄儿（SGA）、持续气道正压通气（CPAP）、吸氧、入住新生儿重症监护病房（NICU）、败血症、低血糖、短暂性新生儿呼吸急促（TTNB）和黄疸的发生率更高（P<0.001）。校正分析显示，暴露组发生SGA的几率更高（校正比值比[aOR]为1.30；95%置信区间[CI]为1.20 - 1.41）、入住NICU的几率更高（aOR为1.16；95%CI为0.99 - 1.36）以及高胆红素血症的几率更高（aOR为1.49；95%CI为1.38 - 1.61）。在28至33周之间暴露与吸氧几率增加（aOR为1.42；95%CI为1.21 - 1.67）和TTNB几率增加（aOR为1.40；95%CI为1.00 - 1.94）相关。