Abstract
Objective:Although antenatal corticosteroids(ACS)promote fetal lung maturation and reduce neonatal mortality,their use remains controversial.This study retrospectively analyzes the use of ACS and its impact on fetal outcomes among neonates born at Shanghai Sixth People's Hospital,aiming to provide baseline data to guide standardized ACS administration.
Methods:Neonates born at Shanghai Sixth People's Hospital from January 1,2015,to December 31,2019,were retrospectively included.Data on maternal and neonatal demographics,perinatal conditions,and neonatal outcomes were collected.Based on gestational age(GA),subjects were grouped as follows:Group A(<28+0 weeks),Group B(28+0-31+6 weeks),Group C(32+0-33+6 weeks),Group D(34+0-36+6 weeks),and Group E(≥37 weeks).ACS usage across groups was analyzed.
Results:A total of 13 709 neonates were included.The ACS regimen for their mother consisted of 6 mg intramuscular dexamethasone every 12 hours for 4 doses(one course).Of all cases,95.41%(13 080/13 709)received no ACS,0.07%(9/13 709)received fewer than one full course,4.50%(617/13 709)received one to three full courses,and 0.02%(3/13 709)had unknown course details.ACS usage rates were:Group A,64.10%(25/39);Group B,89.34%(109/122);Group C,86.07%(105/122);Group D,43.43%(347/799);Group E,0.32%(40/12 620).In each treatment course,the comparison results showed that:in the usage of less than one course,the proportions in Group A(0),Group B(0),Group C(0),and Group D(0.29%)were all lower than those in Group E(20.00%),and there were significant differences(all P<0.05);in the usage of one course,the proportions in Group A(100%),Group B(93.58%),Group C(93.33%),and Group D(95.97%)were all higher than those in Group E(75.00%),and there were significant differences(all P<0.05);in the cases of 2 and 3 courses,there was no significant difference among the groups(all P>0.05).Preterm birth,multiple gestation,gestational hypertension,gestational diabetes,and premature rupture of membranes(PROM)were identified as independent risk factors influencing ACS use(all P<0.05).Among preterm infants with GA<34+0 weeks,the incidence of fetal distress was 14.23%(34/239)in the ACS group and 13.64%(6/44)in the non-ACS group;neonatal asphyxia incidence was 32.64%(78/239)vs 38.64%(17/44),respectively.There were no statistically significant differences in the incidence of fetal distress or neonatal asphyxia between the groups(all P>0.05).
Conclusion:The increased probability of ACS use in newborn mothers is associated with high-risk factors such as preterm birth,multiple gestation,gestational hypertension,gestational diabetes,and PROM.These factors should be comprehensively considered during clinical decision-making,among preterm infants with GA<34+0 weeks,the use of ACS does not significantly reduce the incidence of fetal distress or neonatal asphyxia.关键词
新生儿/产前糖皮质激素/地塞米松/新生儿窒息/胎儿宫内窘迫Key words
neonate/antenatal corticosteroids/dexamethasone/fetal distress/neonatal asphyxia
