Antenatal corticosteroids and outcomes of preterm small-for-gestational-age neonates in a single medical center.
Antenatal corticosteroids and outcomes of preterm small-for-gestational-age neonates in a single medical center.
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在一个医疗中心，早产小胎龄新生儿的产前皮质类固醇和结果。
DOI：
10.5468/ogs.2018.61.1.7
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发表时间：
2018-01
影响因子：
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通讯作者：
Wie JH
中科院分区：
文献类型：
--
作者：
Kim WJ;Han YS;Ko HS;Park IY;Shin JC;Wie JH
本研究探讨了一种产前皮质类固醇（ACS）在早产小胎龄（SGA）新生儿中的作用。本研究为回顾性队列研究。我们比较了接受ACS治疗的妇女和未接受ACS治疗的对照组，并评估了在29至34个完整妊娠周内出生的单胎SGA新生儿的新生儿并发症。孕32周后出生的新生儿分为亚组。进行多变量logistic回归分析。共有82名早产儿符合纳入标准；57例（69.5%）在妊娠32周后出生。在机械通气、癫痫发作、颅内出血、早产儿视网膜病变、坏死性小肠结肠炎、喂养困难和新生儿死亡率方面，母亲接受ACS的婴儿与母亲未接受ACS的婴儿在机械通气、癫痫发作、颅内出血、早产儿视网膜病变、坏死性小肠结肠炎、喂养困难和新生儿死亡率方面无显著差异（均P < 0.05）。然而，母亲接受ACS治疗的新生儿发生呼吸窘迫综合征（RDS）的风险显著增加（调整优势比[aOR]， 3.271； 95%可信区间[CI]， 1.038-10.305； P=0.043）。在孕32周以上出生的新生儿中，在控制混杂因素后，接受ACS的妇女发生新生儿低血糖的风险明显更高（aOR, 5.832; 95% CI, 1.096 ~ 31.031； P=0.039）。在妊娠29 - 34周分娩的SGA新生儿中，ACS并没有改善新生儿的发病率。相反，ACS可能会增加RDS的风险。在32 ~ 34孕周分娩的SGA新生儿中，低血糖的风险显著增加。有SGA早产儿的妇女使用ACS需要进一步评估，特别是在妊娠32周后。
This study investigated the effect of an antenatal corticosteroid (ACS) in preterm small-for-gestational-age (SGA) neonate. This study was a retrospective cohort study. We compared women who received ACS with unexposed controls and evaluated neonatal complications among those having a singleton SGA neonate born between 29 and 34 complete gestational weeks. The neonates born after 32 weeks of gestation were divided into subgroups. Multivariable logistic regression analysis was performed. A total 82 of the preterm infants met inclusion criteria; 57 (69.5%) were born after 32 weeks of gestation. There were no significant differences in terms of mechanical ventilation, seizure, intracranial hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, feeding difficulty, and neonatal mortality between infants whose mothers received ACS ant those whose mothers did not (all P>0.05). However, newborns whose mothers received ACS exhibited a significantly increased risk of developing respiratory distress syndrome (RDS) (adjusted odds ratio [aOR], 3.271; 95% confidence interval [CI], 1.038–10.305; P=0.043). In case of neonates born beyond 32 weeks of gestation, the risk of neonatal hypoglycemia was significantly higher in women receiving ACS after controlling for confounding factors (aOR, 5.832; 95% CI, 1.096–31.031; P=0.039). ACS did not improve neonatal morbidities, in SGA neonates delivered between 29 and 34 gestational weeks. Rather, ACS could increase the risk of RDS. In cases of SGA neonate delivered between 32 and 34 complete gestational weeks, the risk of hypoglycemia was significantly increased. The use of ACS in women with preterm SGA infants needs to be evaluated further, especially after 32 weeks' gestation.