PDF(Pubmed)
Abstract：
UNASSIGNED: Prematurity is the highest risk for under-five mortality globally. The aim of the study was to assess the effect of antenatal dexamethasone on neonatal mortality in early preterm in a resource-constrained setting without assisted ventilation.
UNASSIGNED: This retrospective (2008-2013) cohort study in clinics for refugees/migrants on the Thai-Myanmar border included infants born <34 weeks gestation at home, in, or on the way to the clinic. Dexamethasone, 24 mg (three 8 mg intramuscular doses, every 8 hours), was prescribed to women at risk of preterm birth (28 to <34 weeks). Appropriate newborn care was available: including oxygen but not assisted ventilation. Mortality and maternal fever were compared by the number of doses (complete: three, incomplete (one or two), or no dose). A sub-cohort participated in neurodevelopmental testing at one year.
UNASSIGNED: Of 15,285 singleton births, 240 were included: 96 did not receive dexamethasone and 144 received one, two or three doses (56, 13 and 75, respectively). Of live-born infants followed to day 28, (n=168), early neonatal and neonatal mortality/1,000 livebirths (95%CI) with complete dosing was 217 (121-358) and 304 (190-449); compared to 394 (289-511) and 521 (407-633) with no dose. Compared to complete dosing, both incomplete and no dexamethasone were associated with elevated adjusted ORs 4.09 (1.39 to 12.00) and 3.13 (1.14 to 8.63), for early neonatal death. By contrast, for neonatal death, while there was clear evidence that no dosing was associated with higher mortality, adjusted OR 3.82 (1.42 to 10.27), the benefit of incomplete dosing was uncertain adjusted OR 1.75 (0.63 to 4.81). No adverse impact of dexamethasone on infant neurodevelopmental scores (12 months) or maternal fever was observed.
UNASSIGNED: Neonatal mortality reduction is possible with complete dexamethasone dosing in pregnancies at risk of preterm birth in settings without capacity to provide assisted ventilation.
UNASSIGNED: This retrospective (2008-2013) cohort study in clinics for refugees/migrants on the Thai-Myanmar border included infants born <34 weeks gestation at home, in, or on the way to the clinic. Dexamethasone, 24 mg (three 8 mg intramuscular doses, every 8 hours), was prescribed to women at risk of preterm birth (28 to <34 weeks). Appropriate newborn care was available: including oxygen but not assisted ventilation. Mortality and maternal fever were compared by the number of doses (complete: three, incomplete (one or two), or no dose). A sub-cohort participated in neurodevelopmental testing at one year.
UNASSIGNED: Of 15,285 singleton births, 240 were included: 96 did not receive dexamethasone and 144 received one, two or three doses (56, 13 and 75, respectively). Of live-born infants followed to day 28, (n=168), early neonatal and neonatal mortality/1,000 livebirths (95%CI) with complete dosing was 217 (121-358) and 304 (190-449); compared to 394 (289-511) and 521 (407-633) with no dose. Compared to complete dosing, both incomplete and no dexamethasone were associated with elevated adjusted ORs 4.09 (1.39 to 12.00) and 3.13 (1.14 to 8.63), for early neonatal death. By contrast, for neonatal death, while there was clear evidence that no dosing was associated with higher mortality, adjusted OR 3.82 (1.42 to 10.27), the benefit of incomplete dosing was uncertain adjusted OR 1.75 (0.63 to 4.81). No adverse impact of dexamethasone on infant neurodevelopmental scores (12 months) or maternal fever was observed.
UNASSIGNED: Neonatal mortality reduction is possible with complete dexamethasone dosing in pregnancies at risk of preterm birth in settings without capacity to provide assisted ventilation.
摘要：
早产是全球五岁以下儿童死亡的最高风险。该研究的目的是评估在资源有限的情况下，在没有辅助通气的情况下，产前地塞米松对早期早产新生儿死亡率的影响。
■这项回顾性（2008-2013年）队列研究在泰国-缅甸边境的难民/移民诊所进行，其中包括在家中妊娠34周以下的婴儿，in,或者在去诊所的路上.地塞米松,24毫克（三个8毫克肌肉内剂量，每8小时)，为有早产风险的妇女开处方（28至<34周）。适当的新生儿护理是可用的：包括氧气，但不辅助通气。死亡率和产妇发烧通过剂量数量进行比较（完整：三个，不完整（一个或两个），或无剂量)。一个子队列在一年时参与了神经发育测试。
■在15,285个单胎婴儿中，240人包括：96人没有接受地塞米松，144人接受了地塞米松，两个或三个剂量（56，13和75，分别）。在第28天之后的活产婴儿中，（n=168），完全给药的早期新生儿和新生儿死亡率/1,000例活产(95CI)为217例(121-358例)和304例(190-449例);与未给药的394例(289-511例)和521例(407-633例)相比.与完全给药相比，不完全和无地塞米松均与升高的校正ORs4.09(1.39至12.00)和3.13(1.14至8.63)相关,新生儿早期死亡。相比之下,新生儿死亡，虽然有明确的证据表明，没有剂量与更高的死亡率相关，调整后OR3.82（1.42至10.27），不完全给药的获益不确定,校正OR为1.75(0.63~4.81).没有观察到地塞米松对婴儿神经发育评分（12个月）或产妇发热的不利影响。
■在没有能力提供辅助通气的情况下，在有早产风险的孕妇中，完全给予地塞米松可以降低新生儿死亡率。
■这项回顾性（2008-2013年）队列研究在泰国-缅甸边境的难民/移民诊所进行，其中包括在家中妊娠34周以下的婴儿，in,或者在去诊所的路上.地塞米松,24毫克（三个8毫克肌肉内剂量，每8小时)，为有早产风险的妇女开处方（28至<34周）。适当的新生儿护理是可用的：包括氧气，但不辅助通气。死亡率和产妇发烧通过剂量数量进行比较（完整：三个，不完整（一个或两个），或无剂量)。一个子队列在一年时参与了神经发育测试。
■在15,285个单胎婴儿中，240人包括：96人没有接受地塞米松，144人接受了地塞米松，两个或三个剂量（56，13和75，分别）。在第28天之后的活产婴儿中，（n=168），完全给药的早期新生儿和新生儿死亡率/1,000例活产(95CI)为217例(121-358例)和304例(190-449例);与未给药的394例(289-511例)和521例(407-633例)相比.与完全给药相比，不完全和无地塞米松均与升高的校正ORs4.09(1.39至12.00)和3.13(1.14至8.63)相关,新生儿早期死亡。相比之下,新生儿死亡，虽然有明确的证据表明，没有剂量与更高的死亡率相关，调整后OR3.82（1.42至10.27），不完全给药的获益不确定,校正OR为1.75(0.63~4.81).没有观察到地塞米松对婴儿神经发育评分（12个月）或产妇发热的不利影响。
■在没有能力提供辅助通气的情况下，在有早产风险的孕妇中，完全给予地塞米松可以降低新生儿死亡率。
