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：无既往分娩史的剖宫产（CS）与较差的新生儿呼吸结局相关。已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（ACS）的足月儿的新生儿结局，结果显示ACS可降低新生儿呼吸窘迫综合征（RDS）、新生儿暂时性呼吸过速（TTN）、新生儿重症监护室（NICU）入住率及NICU住院时长的风险。方法：本回顾性队列研究旨在对比足月择期剖宫产娩出的新生儿中，暴露与未暴露于ACS的新生儿结局。结局指标包括新生儿出生时并发症、新生儿呼吸并发症及总体新生儿并发症。同时分析产妇人口统计学特征与产科数据以控制混杂因素。结果：共计334名新生儿符合纳入标准。其中三分之一的研究对象（n=129；38.6%）接受了ACS治疗。本研究发现，暴露于ACS组的新生儿发生RDS（比值比[OR]=1.250；95%置信区间[CI]：0.454~3.442）、TTN（OR=1.623；95%CI：0.556~4.739）及NICU入住（OR=2.155；95%CI：0.474~9.788）的风险更高，但差异无统计学意义。在校正孕龄与动脉高血压因素后，暴露于ACS组的新生儿发生RDS（OR=0.732；95%CI：0.240~2.232）、TTN（OR=0.959；95%CI：0.297~3.091）及NICU入住（OR=0.852；95%CI：0.161~4.520）的风险反而降低。结论：本研究结果证实了剖宫产相关呼吸并发症与孕龄之间的已知关联，支持近期指南倡导的将择期剖宫产推迟至孕龄39周的建议。