مقايسه فراواني مرگ ومير و عوارض نوزادي در درمان تك دوره اي و چند دوره اي كورتيكواستروئيد پيش از زايمان در نوزادان نارس

A comparison of the neonatesʹ mortality and morbidity in single-dose and multi-dose antenatal corticosteroid in premature infants

Background: One of the most common factors of mortality and morbidity in premature infants is respiratory distress syndrome. Corticosteroid administration to pre gnant women at risk of preterm delivery has been proven to reduce incidence of neonatal death, respiratory distress syndrome and other morbidity in preterm neonate. Repeated administration of antenatal corticosteroids is a common practice in women who have not delivered 7-14 days after the first course of corticosteroid. However, the benefits of this practice as compared to single-course administration have not been proven and many conlroversial researches are there in this case. Methods: This cohort study has been performed with matched controls on 108 preterm neonates (54 neonates in single course and 54 repeated courses). The surveyed variable measures were several maternal and neonatal characteristics, the incidences of neonatal death, respiratory distress syndrome, intraventricular hemorrhage and necrotizing entrocolitis. Matching criteria in neonates were sex, route of delivery and gestational age at delivery. We recorded the obstetrical data from maternal files and then neonatal data in the form of prospective method. Result: There are no statistically significant differences in mean birth weight, head circumference and APGAR score between single and multiple course of antenatal corticosteroid. The incidences and odds-ratio of neonatal death and morbidity were compared between the two groups as follows: neonatal death (7.4% and 13.0% OR=1.80), respiratory distress syndrome (29.8% and 35.0% OR=1.30), intraventricular hemorrhage (22.2% and 22.2% OR=LO) and necrotizing entrocolitis (11.1% and 9.2% OR=0.7). Conclusion: It seems that multiple courses of antenatal corticosteroids do not reduce mortality and morbidity in neonates.