JAMA Netw open:晚期早产儿类固醇的使用和相关新生儿呼吸疾病发病率之间的关系

2022-05-26 liangying MedSci原创

关于产前使用类固醇对晚期早产儿的影响,未来还需要进一步研究。

早产产前给予糖皮质激素可刺激胎儿肺表面活性物质的产生,从而降低新生儿呼吸系统疾病的发病率。此外,糖皮质激素还可以减少早产的其他并发症,尤其是在极早产的情况下。2016年,Gyamfi Bannerman等人发表了大规模随机临床试验(早产产前给予类固醇【ALPS】试验)的结果,该试验评估了早产晚期(即妊娠34-36周)使用类固醇的效果。与足月(妊娠37周)新生儿相比,在这些胎龄出生的婴儿发生并发症的风险更高,尤其是在呼吸系统发病率方面。

本研究的目的是评估早产末期应用类固醇对新生儿呼吸系统有益的新证据是否与产科实践的变化以及新生儿分娩后辅助通气的使用有关。

这项横断面研究的时间为2015年2月1日至2017年10月31日,纳入的研究对象为出生在34至36周之间的早产活产独生儿,这些新生儿都是母亲在妊娠期无糖尿病的人。使用泊松回归模型进行中断时间序列分析。数据分析时间为2022年7月11日至2022年11月9日。

研究最后共纳入707862例新生儿,分为三个阶段:论文传播前12个月(n=250643)、传播期(n=195 736)和传播后12个月(n=261493)。大多数婴儿出生于妊娠36周。研究发现,与根据分娩前预测趋势相比,该论文发表后临床中类固醇使用率从5.0%上升到11.7%,辅助通气使用从8.9%下降到8.2%辅助通气使用时间超过6小时未观察到任何变化

“早产类固醇试验”发表前后的类固醇和辅助通气使用的调整趋势

总之,这项横断面研究发现,ALPS试验数据的发表和传播与美国晚期早产儿使用类固醇的数量增加有关。相应地,立即辅助通气的使用也减少了,这一发现与初级临床试验结果一致,并为其推广提供了证据。未来需要进一步研究对新生儿重症监护资源使用、新生儿低血糖发生率以及在ALPS试验后期使用类固醇的适宜性的影响,以全面了解产前使用类固醇对晚期早产儿的影响。

参考文献:Clapp MA, Melamed A, Freret TS, James KE, Gyamfi-Bannerman C, Kaimal AJ. US Incidence of Late-Preterm Steroid Use and Associated Neonatal Respiratory Morbidity After Publication of the Antenatal Late Preterm Steroids Trial, 2015-2017. JAMA Netw Open. 2022;5(5):e2212702. doi:10.1001/jamanetworkopen.2022.12702

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    2023-02-18 canlab
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    2023-03-06 feather89
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    2022-05-26 肿瘤克星

    JAMA上文章都是顶级的,谢谢梅斯及时上新

    0