Modanlou H D, Beharry K, Padilla G, Iriye B
Division of Neonatal-Perinatal Medicine, University of California, Irvine Medical Center, Orange 92688, USA.
J Perinatol. 1996 Nov-Dec;16(6):422-8; quiz 429-30.
Antenatal corticosteroids in preterm pregnancy may result in the reduction of the incidence of respiratory distress syndrome (RDS) and neonatal mortality. It is well known that postnatal use of surfactant in very low birth weight (VLBW) infants with RDS results in decreased neonatal morbidity and mortality. To evaluate the additive beneficial effects of combined antenatal corticosteroids and postnatal use of rescue surfactant on the outcome of VLBW infants, we retrospectively reviewed 286 maternal/infant charts of preterm infants with gestational ages 23 to 32 weeks and birth weights 501 to 1500 gm who were born at our institution from 1991 through 1994. Of the 87 (30%) infants who were treated with corticosteroids before birth, 41 (47%) had RDS, and of the 199 (70%) infants who were not treated with corticosteroids before birth, 162 (81%) had RDS (p < 0.001). The infants who had RDS and who were treated with corticosteroids before birth had a decreased incidence of pulmonary air leaks and a decreased need for diuretic therapy. In addition, they had a significant reduction in O2 requirement and ventilator settings as reflected by FIO2, mean airway pressure, ventilator rate, O2 index, and A-aDO2 before they received the first dose of rescue surfactant (p < 0.05 to p < 0.01) in contrast to other VLBW infants who had RDS and who were not treated with corticosteroids before birth. We conclude that antenatal corticosteroid therapy in threatened premature labor combined with the use of postnatal rescue surfactant is associated with a decreased incidence of RDS and may be beneficial for reducing the severity of RDS and improving the eventual outcome of VLBW infants.
早产时使用产前皮质类固醇可能会降低呼吸窘迫综合征（RDS）的发生率和新生儿死亡率。众所周知，出生后对患有RDS的极低出生体重（VLBW）婴儿使用表面活性剂可降低新生儿发病率和死亡率。为了评估产前皮质类固醇与出生后使用抢救性表面活性剂联合使用对VLBW婴儿结局的附加有益效果，我们回顾性分析了1991年至1994年在我们机构出生的286例孕周为23至32周、出生体重为501至1500克的早产母婴病历。在出生前接受皮质类固醇治疗的87例（30%）婴儿中，41例（47%）患有RDS；在出生前未接受皮质类固醇治疗的199例（70%）婴儿中，162例（81%）患有RDS（p<0.001）。出生前接受皮质类固醇治疗且患有RDS的婴儿发生肺气漏的发生率降低，利尿剂治疗需求减少。此外，与出生前未接受皮质类固醇治疗且患有RDS的其他VLBW婴儿相比，他们在接受第一剂抢救性表面活性剂之前，氧需求和呼吸机设置显著降低，这通过FIO2、平均气道压力、呼吸机频率、氧指数和A-aDO2反映（p<0.05至p<0.01）。我们得出结论，先兆早产时的产前皮质类固醇治疗与出生后使用抢救性表面活性剂联合使用与RDS发生率降低相关，可能有助于降低RDS的严重程度并改善VLBW婴儿的最终结局。
