摘要
目的探讨晚期早产儿产前糖皮质激素(antenatal corticosteroid,ACS)暴露对新生儿结局的影响。方法本研究为回顾性队列研究。选取2021年1月至2024年6月在同济大学附属东方医院出生的胎龄34+0~36周+6的晚期早产儿406例,根据是否有ACS暴露分为ACS暴露组(n=254)和对照组(n=152),比较2组母体特征、新生儿特征和结局[呼吸系统疾病(包括呼吸窘迫综合征、呼吸衰竭和支气管肺发育不良)、新生儿低血糖和早发型败血症]的差异,并根据胎数(双胎154例,单胎252例)和胎龄(34+0~34周+696例;35+0~35周+6111例;36+0~36周+6199例)进行分层,分析ACS暴露对新生儿结局的影响。根据是否罹患呼吸系统疾病分为患病组(n=13)与未患病组(n=393),分析晚期早产儿呼吸系统疾病的危险因素。采用独立样本t检验、Mann-WhitneyU检验、χ2检验以及多因素logistic回归进行统计分析。结果ACS暴露组孕母辅助生殖技术受孕[53.1%(135/254)与37.5%(57/152),χ2=9.37]、双胎[43.3%(110/254)与28.9%(44/152),χ2=6.84]、剖宫产[83.5%(212/254)与66.4%(101/152),χ2=15.66]和新生儿转新生儿重症监护病房的比例[59.1%(150/254)与40.8%(62/152),χ2=12.61]均高于对照组(P值均<0.05);ACS暴露组与对照组新生儿结局——呼吸系统疾病[3.1%(8/254)与3.3%(5/152),χ2=0.01]、早发型败血症[1.6%(4/254)与1.3%(2/152),χ2=0.71]和新生儿低血糖的发生率[1.6%(4/254)与1.3%(2/152),χ2=0.71]差异均无统计学意义(P值均>0.05)。无论是单胎还是双胎,或者不同胎龄分层,ACS暴露组与对照组新生儿呼吸系统疾病、早发型败血症以及新生儿低血糖发生率差异均无统计学意义(P值均>0.05)。多因素logistic回归分析发现,对于新生儿呼吸系统疾病来说,ACS暴露不是保护因素(OR=0.37,95%CI:0.10~1.39,P=0.144),母亲糖代谢异常(孕前糖尿病/妊娠期糖尿病)是危险因素(OR=5.26,95%CI:1.57~17.71,P=0.007),出生胎龄大是保护因素(OR=0.34,95%CI:0.15~0.78,P=0.012)。结论孕34+0~36周+6有早产高风险孕妇应用ACS预防晚期早产儿呼吸系统疾病未见明显获益,但也未增加晚期早产儿低血糖、早发型败血症风险。母体糖代谢异常与出生胎龄小的晚期早产儿发生呼吸系统疾病的风险高。
Objective:To investigate the impact of antenatal corticosteroid(ACS)exposure on neonatal outcomes in late preterm infants.Methods:This retrospective cohort study analyzed 406 late preterm infants(gestational age 34+0-36+6 weeks)born at Tongji University Affiliated Dongfang Hospital between January 2021 and June 2024.Participants were divided into ACS-exposed(n=254)and control(n=152)groups.Maternal characteristics,neonatal profiles,and outcomes[respiratory disorders(respiratory distress syndrome,respiratory failure,bronchopulmonary dysplasia),neonatal hypoglycemia,and early-onset sepsis]were compared.And they were stratified by plurality(154 twins,252 singletons)and gestational age(96 at 34+0-34+6 weeks;111 at 35+0-35+6 weeks;199 at 36+0-36+6 weeks),the effects of ACS exposure on neonatal outcomes were analyzed.Late preterm infants were also divided into affected(n=13)and unaffected(n=393)groups according to whether they had respiratory disorders,and the risk factors of respiratory disorders were analyzed.Statistical methods included independent t-tests,Mann-Whitney U,Chi-square test,and multivariate logistic regression.Results:The ACS-exposed group exhibited significantly higher rates of assisted reproductive technology conception[53.1%(135/254)vs.37.5%(57/152),χ2=9.37],twin pregnancy[43.3%(110/254)vs.28.9%(44/152),χ2=6.84],cesarean delivery[83.5%(212/254)vs.66.4%(101/152),χ2=15.66],and neonatal intensive care unit admission than those in the control group[59.1%(150/254)vs.40.8%(62/152),χ2=12.61](all P<0.05).No significant differences emerged between ACS-exposed and control groups in respiratory disorders[3.1%(8/254)vs.3.3%(5/152),χ2=0.01],early-onset sepsis[1.6%(4/254)vs.1.3%(2/152),χ2=0.71],or neonatal hypoglycemia[1.6%(4/254)vs.1.3%(2/152),χ2=0.71](all P>0.05).Stratified analyses by plurality or gestational age strata revealed no significant differences in respiratory disorders,early-onset sepsis or neonatal hypoglycemia between ACS-exposed and control groups(all P>0.05).Multivariate logistic regression identified ACS exposure as non-protective against respiratory disorders(OR=0.37,95%CI:0.10-1.39,P=0.144),with maternal glucose metabolism disorders(pre-gestational/gestational diabetes)as a risk factor(OR=5.26,95%CI,1.57-17.71,P=0.007)and higher gestational age as protective(OR=0.34,95%CI:0.15-0.78,P=0.012).Conclusions:ACS administration at 34+0-36+6 weeks demonstrated no significant benefits for preventing respiratory disorders in late preterm infants and did not increase risks of hypoglycemia or early-onset sepsis.Maternal glucose dysregulation and lower gestational age elevate respiratory morbidity risk in this population.
作者
王君
刘铭
孙雪皎
倪晓田
付菲
王凌
雷胜瑶
Wang Jun;Liu Ming;Sun Xuejiao;Ni Xiaotian;Fu Fei;Wang Ling;Lei Shengyao(Department of Obstetrics,Taicang First People's Hospital,Taicang 215400,China;Department of Obstetrics,Tongji University Affiliated Dongfang Hospital,Shanghai 200123,China;Department of Obstetrics,Zhenjiang Fourth People's Hospital,Zhenjiang 212000,China)
出处
《中华围产医学杂志》
北大核心
2025年第8期625-632,共8页
Chinese Journal of Perinatal Medicine
基金
浦东新区高峰高原学科建设临床医学新质专科(专病)项目(2024-PWXZ-15)。
关键词
晚期早产
早产儿
产前糖皮质激素
呼吸系统疾病
Late preterm birth
Preterm infants
Antenatal corticosteroids
Respiratory morbidity
