Background: Antenatal corticosteroid (ACS) treatment has been proven to decrease rates of adverse perinatal outcomes when administered to pregnant women at risk for preterm delivery. Given the uncertainty about the be...Background: Antenatal corticosteroid (ACS) treatment has been proven to decrease rates of adverse perinatal outcomes when administered to pregnant women at risk for preterm delivery. Given the uncertainty about the benefit of ACS according to gestational age, we aimed to examine whether there was any benefit of ACS on perinatal mortality and respiratory distress syndrome (RDS) according to different gestational ages at birth. Methods: Secondary analysis of data from an observational prospective chart review study was conducted in four hospitals located in the Mwanza region, Tanzania. The study population consisted of singleton infants delivered between 27 and 34 weeks of gestation between July 2019 and February 2020. Sociodemographic and medical data were recorded from participants’ medical records. Results: Over an eight-month period, 838 preterm singletons were delivered between 27 and 34 weeks of gestation. Three hundred and twelve (37.2%) pregnant women received at least one dose of ACS. Among infants exposed to ACS, perinatal mortality rates were significantly lower than those without exposure at the 27th week (27.8% vs 94.4%, P < 0.001), the 29th week (13.3% vs 51.4%, P = 0.012) and the 34th week (3.0% vs 18.2%, P < 0.001). Among infants exposed to ACS, the RDS rate was significantly lower than those without exposure only at the 32nd week (9.5% vs 25.0%, P = 0.039). Conclusion: Our findings add to the literature about the benefits of ACS for preterm infants of various gestational ages in low-resource settings. Compared to unexposed infants, those exposed to ACS and born at 27th and 34th weeks of gestation experienced lower rates of perinatal mortality. Future research, especially among infants born before the 27th week of pregnancy, is a priority.展开更多
The aim of this manuscript is to discuss the practice of antenatal corticosteroids administration for fetal maturation in severe acute respiratory syndrome coronavirus 2 positive pregnant women.Recent high-quality evi...The aim of this manuscript is to discuss the practice of antenatal corticosteroids administration for fetal maturation in severe acute respiratory syndrome coronavirus 2 positive pregnant women.Recent high-quality evidence supports the use of dexamethasone in the treatment of hospitalized patients with coronavirus disease 2019(COVID-19).Randomized disease outcome data have identified an association between disease stage and treatment outcome.In contrast to patients with more severe forms who benefit from dexamethasone,patients with mild disease do not appear to improve and may even be harmed by this treatment.Therefore,indiscriminate usage of fluorinated corticosteroids for fetal maturation,regardless of disease trajectory,is unadvisable.Obstetrical care needs to be adjusted during the COVID-19 pandemic with careful attention paid to candidate selection and risk stratification.展开更多
Background:Antenatal corticosteroids(ACS)can significantly improve the outcomes of preterm infants.This study aimed to describe the ACS use rates among preterm infants admitted to Chinese neonatal intensive care units...Background:Antenatal corticosteroids(ACS)can significantly improve the outcomes of preterm infants.This study aimed to describe the ACS use rates among preterm infants admitted to Chinese neonatal intensive care units(NICU)and to explore perinatal factors associated with ACS use,using the largest contemporary cohort of very preterm infants in China.Methods:This cross-sectional study enrolled all infants born at 24^(+0)to 31^(+6)weeks and admitted to 57 NICUs of the Chinese Neonatal Network from January 1st,2019 to December 30th,2019.The ACS administration was defined as at least one dose of dexamethasone and betamethasone given before delivery.Multiple logistic regressions were applied to determine the association between perinatal factors and ACS usage.Results:A total of 7828 infants were enrolled,among which 6103(78.0%)infants received ACS.ACS use rates increased with increasing gestational age(GA),from 177/259(68.3%)at 24 to 25 weeks’gestation to 3120/3960(78.8%)at 30 to 31 weeks’gestation.Among infants exposed to ACS,2999 of 6103(49.1%)infants received a single complete course,and 33.4%(2039/6103)infants received a partial course.ACS use rates varied from 30.2%to 100%among different hospitals.Multivariate regression showed that increasing GA,born in hospital(inborn),increasing maternal age,maternal hypertension and premature rupture of membranes were associated with higher likelihood to receive ACS.Conclusions:The use rate of ACS remained low for infants at 24 to 31 weeks’gestation admitted to Chinese NICUs,with fewer infants receiving a complete course.The use rates varied significantly among different hospitals.Efforts are urgently needed to propose improvement measures and thus improve the usage of ACS.展开更多
Background The most common cause of death among preterm infants in low-and middle-income countries is respiratory distress syndrome.The purpose of this review was to assess whether antenatal corticosteroids given to w...Background The most common cause of death among preterm infants in low-and middle-income countries is respiratory distress syndrome.The purpose of this review was to assess whether antenatal corticosteroids given to women at risk of preterm birth at≤34 weeks of gestation reduce rates of neonatal mortality and respiratory distress syndrome in low-and middle-income countries.Methods Two reviewers independently searched four databases including MEDLINE(through PubMed),CINAHL,Embase,and Cochrane Libraries.We did not apply any language or date restrictions.All publications up to April 2020 were included in this search.Results The search yielded 71 articles,10 of which were included in this review(3 randomized controlled trials,7 observa-tional studies,36,773 neonates).The majority of studies reported associations between exposure to antenatal corticosteroids and lower rates of neonatal mortality and respiratory distress syndrome.However,a few studies reported that antenatal corticosteroids were not associated with improved preterm birth outcomes.Conclusions Most of the studies in low-and middle-income countries showed that use of antenatal corticosteroids in hospitals with high levels of neonatal care was associated with lower rates of neonatal mortality and respiratory distress syndrome.However,the findings are inconclusive because some studies in low-resource settings reported that antenatal corticosteroids had no benefit in reducing rates of neonatal mortality or respiratory distress syndrome.Further research on the impact of antenatal corticosteroids in resource-limited settings in low-income countries is a priority.展开更多
Background: To investigate the blood glucose level response of diabetic pregnant women when administrating antenatal dexamethasone to accelerate fetal lung maturity in different routes. Methods: This prospective cohor...Background: To investigate the blood glucose level response of diabetic pregnant women when administrating antenatal dexamethasone to accelerate fetal lung maturity in different routes. Methods: This prospective cohort study included 60 pregnant women with diabetes who required promotion of fetal lung maturity in Peking University First Hospital from January 2013 to April 2015. Dexamethasone was administered by IM (n = 29) or IAC (n = 31). Blood glucose level was monitored before injection, and 1 day, 2 days and 3 days after injection. Results: In the intramuscular injection group, the preprandial and postprandial blood glucose concentration was significantly elevated in the first two days (P < 0.001), and the postprandial blood glucose level was still higher than basal level (P = 0.034) on the third day. In the intra-amniotic injection group, the preprandial and postprandial blood glucose concentration was also significantly elevated on the first day (P < 0.001), but soon returned to the basal level on the second day. No significant difference was found in the magnitude of glucose increase between the two groups. Conclusion: Blood glucose level is significantly influenced by intramuscular injection of antenatal dexamethasone rather than amniotic cavity injection.展开更多
文摘Background: Antenatal corticosteroid (ACS) treatment has been proven to decrease rates of adverse perinatal outcomes when administered to pregnant women at risk for preterm delivery. Given the uncertainty about the benefit of ACS according to gestational age, we aimed to examine whether there was any benefit of ACS on perinatal mortality and respiratory distress syndrome (RDS) according to different gestational ages at birth. Methods: Secondary analysis of data from an observational prospective chart review study was conducted in four hospitals located in the Mwanza region, Tanzania. The study population consisted of singleton infants delivered between 27 and 34 weeks of gestation between July 2019 and February 2020. Sociodemographic and medical data were recorded from participants’ medical records. Results: Over an eight-month period, 838 preterm singletons were delivered between 27 and 34 weeks of gestation. Three hundred and twelve (37.2%) pregnant women received at least one dose of ACS. Among infants exposed to ACS, perinatal mortality rates were significantly lower than those without exposure at the 27th week (27.8% vs 94.4%, P < 0.001), the 29th week (13.3% vs 51.4%, P = 0.012) and the 34th week (3.0% vs 18.2%, P < 0.001). Among infants exposed to ACS, the RDS rate was significantly lower than those without exposure only at the 32nd week (9.5% vs 25.0%, P = 0.039). Conclusion: Our findings add to the literature about the benefits of ACS for preterm infants of various gestational ages in low-resource settings. Compared to unexposed infants, those exposed to ACS and born at 27th and 34th weeks of gestation experienced lower rates of perinatal mortality. Future research, especially among infants born before the 27th week of pregnancy, is a priority.
文摘The aim of this manuscript is to discuss the practice of antenatal corticosteroids administration for fetal maturation in severe acute respiratory syndrome coronavirus 2 positive pregnant women.Recent high-quality evidence supports the use of dexamethasone in the treatment of hospitalized patients with coronavirus disease 2019(COVID-19).Randomized disease outcome data have identified an association between disease stage and treatment outcome.In contrast to patients with more severe forms who benefit from dexamethasone,patients with mild disease do not appear to improve and may even be harmed by this treatment.Therefore,indiscriminate usage of fluorinated corticosteroids for fetal maturation,regardless of disease trajectory,is unadvisable.Obstetrical care needs to be adjusted during the COVID-19 pandemic with careful attention paid to candidate selection and risk stratification.
基金Tianjin Key Medical Discipline(Specialty)Construction Project(No.TJYXZDXK-039A)
文摘Background:Antenatal corticosteroids(ACS)can significantly improve the outcomes of preterm infants.This study aimed to describe the ACS use rates among preterm infants admitted to Chinese neonatal intensive care units(NICU)and to explore perinatal factors associated with ACS use,using the largest contemporary cohort of very preterm infants in China.Methods:This cross-sectional study enrolled all infants born at 24^(+0)to 31^(+6)weeks and admitted to 57 NICUs of the Chinese Neonatal Network from January 1st,2019 to December 30th,2019.The ACS administration was defined as at least one dose of dexamethasone and betamethasone given before delivery.Multiple logistic regressions were applied to determine the association between perinatal factors and ACS usage.Results:A total of 7828 infants were enrolled,among which 6103(78.0%)infants received ACS.ACS use rates increased with increasing gestational age(GA),from 177/259(68.3%)at 24 to 25 weeks’gestation to 3120/3960(78.8%)at 30 to 31 weeks’gestation.Among infants exposed to ACS,2999 of 6103(49.1%)infants received a single complete course,and 33.4%(2039/6103)infants received a partial course.ACS use rates varied from 30.2%to 100%among different hospitals.Multivariate regression showed that increasing GA,born in hospital(inborn),increasing maternal age,maternal hypertension and premature rupture of membranes were associated with higher likelihood to receive ACS.Conclusions:The use rate of ACS remained low for infants at 24 to 31 weeks’gestation admitted to Chinese NICUs,with fewer infants receiving a complete course.The use rates varied significantly among different hospitals.Efforts are urgently needed to propose improvement measures and thus improve the usage of ACS.
文摘Background The most common cause of death among preterm infants in low-and middle-income countries is respiratory distress syndrome.The purpose of this review was to assess whether antenatal corticosteroids given to women at risk of preterm birth at≤34 weeks of gestation reduce rates of neonatal mortality and respiratory distress syndrome in low-and middle-income countries.Methods Two reviewers independently searched four databases including MEDLINE(through PubMed),CINAHL,Embase,and Cochrane Libraries.We did not apply any language or date restrictions.All publications up to April 2020 were included in this search.Results The search yielded 71 articles,10 of which were included in this review(3 randomized controlled trials,7 observa-tional studies,36,773 neonates).The majority of studies reported associations between exposure to antenatal corticosteroids and lower rates of neonatal mortality and respiratory distress syndrome.However,a few studies reported that antenatal corticosteroids were not associated with improved preterm birth outcomes.Conclusions Most of the studies in low-and middle-income countries showed that use of antenatal corticosteroids in hospitals with high levels of neonatal care was associated with lower rates of neonatal mortality and respiratory distress syndrome.However,the findings are inconclusive because some studies in low-resource settings reported that antenatal corticosteroids had no benefit in reducing rates of neonatal mortality or respiratory distress syndrome.Further research on the impact of antenatal corticosteroids in resource-limited settings in low-income countries is a priority.
文摘Background: To investigate the blood glucose level response of diabetic pregnant women when administrating antenatal dexamethasone to accelerate fetal lung maturity in different routes. Methods: This prospective cohort study included 60 pregnant women with diabetes who required promotion of fetal lung maturity in Peking University First Hospital from January 2013 to April 2015. Dexamethasone was administered by IM (n = 29) or IAC (n = 31). Blood glucose level was monitored before injection, and 1 day, 2 days and 3 days after injection. Results: In the intramuscular injection group, the preprandial and postprandial blood glucose concentration was significantly elevated in the first two days (P < 0.001), and the postprandial blood glucose level was still higher than basal level (P = 0.034) on the third day. In the intra-amniotic injection group, the preprandial and postprandial blood glucose concentration was also significantly elevated on the first day (P < 0.001), but soon returned to the basal level on the second day. No significant difference was found in the magnitude of glucose increase between the two groups. Conclusion: Blood glucose level is significantly influenced by intramuscular injection of antenatal dexamethasone rather than amniotic cavity injection.
