Late-onset Premature Prenatal Application Of Dexamethasone Impact Study Of NRDS

Preterm births is the most common obstetric complications accounted for about 5%～15% of the total amount, it is the leading cause of perinatal and neonatal death serious complications is the most important reason, with the highest incidence of NRDS. In the 1970 s, scholars have found are prone to premature to prenatal application of glucocorticoid, can reduce the incidence of neonatal respiratory distress, So the antenatal corticosteroids are widely used. Glucocorticoids in promoting the role of fetal respiratory mature don’t doubt.Especially for gestational age 37 weeks or less pregnant women with preterm labor. In 2011 for the application of antenatal corticosteroids, the American association of obstetrics and gynecology doctors (ACOG) for medication guide revised again. With the risk of a pre-term birth (gestational age< 34 weeks) of prenatal use of exogenous glucocorticoid, and use a single course of treatment in routine. Late pregnancy (gestational age> 34 weeks) preterm births do not recommend routine use of glucocorticoids, and different versions for the application of glucocorticoid late in pregnancy.However, the security of antenatal corticosteroids, application procedures and gestational age was discussed.OBJECTIVE:To estimate whether antenatal corticosteroids given after fetal lung immaturity inpregnancies at 34 weeks of gestation or more would improve neonatal outcomes and, in particular.respiratory outcomes.METHODS:We compared outcomes of 160 neonates born between 34-37weeks of gestation after fetal lung maturity testing:52 with immature fetal lung indices were treated with antenatal corticosteroids followed by planned delivery within 1 week; 30 with immature fetal lung indices were managed expectantly; and 78 were delivered after mature amniocentesis. Compare three groups of neonatal respiratory distress syndrome, Apgar score, neonatal premature clinical outcome and physical development. All data statistics using SPSS 17,0 statistical software, used chi-square test, t test, P< 0.05 for the difference was statistically significant.RESULTS:(1)Compared corticosteroid-exposed neonates those born after mature amniocentesis with the other two group, corticosteroid-exposed group had lower in birth weight.the differences were not significant(p> 0.05).the differences between length and head size in the three group were not significant (p> 0.05).(2) Expectantly managed neonates were less likely to have the compositeadverse respiratory outcome than the corticosteroid-exposed neonates. although this did not reach statistical significance. After adjustment with the same covariates, neonates born after mature amniocentesis were less likely to have the composite adverse respiratory outcomeand less likely to have thecomposite adverse neonatal outcome compared to the corticosteroid-exposed neonates. (3) Treated with antenatal corticosteroids could make the 1 amellar body increased. the differences between antenatal corticosteroids treated before and after were significant(p< 0.05) (4)Compared with corticosteroid-exposed neonates, the neonates born after expectant management had differences for multiple neonatal morbidities including the composite adverse respiratory outcome, admission to neonatal intensive care,sepsis sepsis, NRDS and oxygen supplementation (15.4%、2.6%、10.0%). the differences were significant(p< 0.05). (5)The lmin,5min Apgar in the three group were not significant (p> 0.05)CONCLUSION:Administration of antenatal corticosteroids after immature fetal lung indicesdid not reduce respiratory morbidity in neonates born at 34 weeks of gestation or more. Our study supports prolonging gestation until delivery is otherwise indicated. Although through the application of antenatal corticosteroids, can not completely avoid the happening of NRDS, but for pregnant women with preterm labor, treatment with dexamethasone to promote fetal lung maturity, can increase fetal lung lamellar corpuscle (LB) content, thus reduce the incidence of neonatal RDS. At the same time, the specification late-onset prenatal application of glucocorticoid to prevent premature NRDS, considering the side effects of glucocorticoid may effects,We should investigate other more method to reduce the incidence of NRDS, to improve the quality of the survival of premature babies.