Antenatal Betamethasone for Women at Risk for Late Preterm Delivery.
Antenatal Betamethasone for Women at Risk for Late Preterm Delivery.
复制标题
DOI：
10.1056/nejmoa1516783
复制
发表时间：
2016-04-07
期刊：
影响因子：
--
通讯作者：
NICHD Maternal–Fetal Medicine Units Network
中科院分区：
文献类型：
--
作者：
Gyamfi-Bannerman C;Thom EA;Blackwell SC;Tita AT;Reddy UM;Saade GR;Rouse DJ;McKenna DS;Clark EA;Thorp JM Jr;Chien EK;Peaceman AM;Gibbs RS;Swamy GK;Norton ME;Casey BM;Caritis SN;Tolosa JE;Sorokin Y;VanDorsten JP;Jain L;NICHD Maternal–Fetal Medicine Units Network
妊娠34至36周(早产晚期)出生的婴儿比妊娠37周或更晚出生的婴儿有更大的不良呼吸系统和其他后果的风险。目前尚不清楚对有晚期早产风险的妇女使用倍他米松是否会降低新生儿患病的风险。我们对单胎妊娠晚期早产风险较高的妇女进行了一项多中心随机试验。参与者被随机分成两组，分别注射12毫克倍他米松或匹配的安慰剂，间隔24小时。主要结果是前72小时内的新生儿综合治疗(持续气道正压或高流量鼻插管至少2小时，至少4小时补充至少30%吸入氧气的氧气，额外的体膜氧合或机械通气)，或72小时前死产或新生儿死亡。2831名患者被随机分为两组。主要结果发生在倍他米松组的11.6%，而安慰剂组为14.4%(相对危险度0.80，95%可信区间0.66-0.97，P=0.02)。在倍他米松组中，严重的呼吸道并发症、新生儿一过性呼吸急促、肺表面活性物质的使用和支气管肺发育不良的发生率也明显较低。绒毛膜羊膜炎或新生儿败血症的发生率在两组之间没有显著差异。倍他米松组新生儿低血糖更为常见。(24.0%对14.9%，相对危险度1.61，95%可信区间1.38-1.88，P<；0.001)对有晚期早产风险的妇女使用倍他米松可显著降低新生儿呼吸道发病率。
Infants born at 34 to 36 weeks’ gestation (late preterm) have greater risks of adverse respiratory and other outcomes, than those born at 37 weeks gestation or later. It is not known whether betamethasone administered to women at risk for late preterm delivery decreases risks of neonatal morbidities. We conducted a multicenter randomized trial of women with a singleton gestation at high risk for late preterm delivery. Participants were randomized to two injections of 12 mg betamethasone or matching placebo 24 hours apart. The primary outcome was a neonatal composite of treatment in the first 72 hours (continuous positive airway pressure or high flow nasal cannula for at least two hours, supplemental oxygen with a fraction of inspired oxygen of at least 30 percent for at least four hours, extra corporeal membrane oxygenation or mechanical ventilation) or stillbirth or neonatal death before 72 hours. 2,831 patients were randomized. The primary outcome occurred in 11.6% of the betamethasone group versus 14.4%, in the placebo group (Relative Risk 0.80, 95% confidence interval 0.66-0.97, P=0.02). Severe respiratory morbidity, transient tachypnea of the newborn, surfactant use, and bronchopulmonary dysplasia were also significantly less common in the betamethasone group. There were no significant differences between groups in the incidence of chorioamnionitis or neonatal sepsis. Neonatal hypoglycemia was more common in the betamethasone group. (24.0% versus 14.9%, RR 1.61, 95% CI 1.38-1.88, P<0.001) Administration of betamethasone to women at risk for late preterm delivery significantly reduced the rate of neonatal respiratory morbidity.