Is there a Role for Antenatal Corticosteroids in Term Infants before Elective Cesarean Section?

Abstract Objective Cesarean section (CS) delivery, especially without previous labor, is associated with worse neonatal respiratory outcomes. Some studies comparing neonatal outcomes between term infants exposed and not exposed to antenatal corticosteroids (ACS) before elective CS revealed that ACS appears to decrease the risk of respiratory distress syndrome (RDS), transient tachypnea of the neonate (TTN), admission to the neonatal intensive care unit (NICU), and the length of stay in the NICU. Methods The present retrospective cohort study aimed to compare neonatal outcomes in infants born trough term elective CS exposed and not exposed to ACS. Outcomes included neonatal morbidity at birth, neonatal respiratory morbidity, and general neonatal morbidity. Maternal demographic characteristics and obstetric data were analyzed as possible confounders. Results A total of 334 newborns met the inclusion criteria. One third of the population study (n=129; 38.6%) received ACS. The present study found that the likelihood for RDS (odds ratio [OR]=1.250; 95% confidence interval [CI]: 0.454-3.442), transient TTN (OR=1.,623; 95%CI: 0.556-4.739), and NIUC admission (OR=2.155; 95%CI: 0.474-9.788) was higher in the ACS exposed group, although with no statistical significance. When adjusting for gestational age and arterial hypertension, the likelihood for RDS (OR=0,732; 95%CI: 0.240-2.232), TTN (OR=0.959; 95%CI: 0.297--3.091), and NIUC admission (OR=0,852; 95%CI: 0.161-4.520) become lower in the ACS exposed group. Conclusion Our findings highlight the known association between CS-related respiratory morbidity and gestational age, supporting recent guidelines that advocate postponing elective CSs until 39 weeks of gestational age.

摘要 目的：剖宫产（Cesarean section, CS）分娩，尤其是未经历既往临产的择期剖宫产，与新生儿不良呼吸结局相关。既往有研究对比了择期剖宫产术前暴露与未暴露于产前糖皮质激素（antenatal corticosteroids, ACS）的足月新生儿的结局，结果显示ACS可降低新生儿呼吸窘迫综合征（respiratory distress syndrome, RDS）、新生儿暂时性呼吸增快症（transient tachypnea of the neonate, TTN）、新生儿重症监护病房（neonatal intensive care unit, NICU）入住率及NICU住院时长的发生风险。
方法：本项回顾性队列研究旨在对比经择期剖宫产分娩、术前暴露与未暴露于ACS的足月新生儿的新生儿结局。结局指标包括出生时新生儿患病率、新生儿呼吸相关患病率及总体新生儿患病率。研究同时分析了产妇人口统计学特征与产科数据作为潜在混杂因素。
结果：最终共334例新生儿符合纳入标准。本研究队列中1/3受试者（n=129；38.6%）接受了ACS治疗。本研究发现，暴露于ACS组新生儿的RDS发生风险（比值比[OR]=1.250；95%置信区间[CI]：0.454~3.442）、TTN发生风险（OR=1.623；95%CI：0.556~4.739）及NICU入住风险（OR=2.155；95%CI：0.474~9.788）均更高，但差异无统计学意义。在校正胎龄与动脉高血压后，暴露于ACS组新生儿的RDS发生风险（OR=0.732；95%CI：0.240~2.232）、TTN发生风险（OR=0.959；95%CI：0.297~3.091）及NICU入住风险（OR=0.852；95%CI：0.161~4.520）均有所降低。
结论：本研究结果进一步证实了剖宫产相关呼吸患病率与胎龄的已知关联，支持近期指南倡导的将择期剖宫产推迟至孕39周的推荐意见。