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Elucidating the Effect of Antenatal Corticosteroids in the Late Preterm Period
Rekha Upadhya1, Sai Bhavana1, Muralidhar V Pai1
1Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India.
Insights
Antenatal corticosteroids given between 34 and 36 weeks gestation significantly reduce respiratory issues and NICU admissions in newborns. This treatment also lowers the need for invasive ventilation and phototherapy for hyperbilirubinemia.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Pharmacology
Background:
- Late preterm birth (34-36 weeks gestation) poses significant risks to neonates.
- Antenatal corticosteroids (ACS) are known to improve outcomes in very preterm infants.
- The efficacy of ACS in the late preterm period requires further investigation.
Purpose of the Study:
- To evaluate the effectiveness of antenatal corticosteroids in pregnancies at risk of late preterm delivery.
- To compare neonatal outcomes between infants exposed and unexposed to ACS in the late preterm period.
Main Methods:
- Retrospective case-control study.
- Inclusion of singleton pregnancies at risk for late preterm delivery (34 0/7 to 36 6/7 weeks).
- Cases received ACS (betamethasone or dexamethasone); controls did not.
Main Results:
- Infants exposed to ACS showed significantly lower rates of NICU admission (15% vs. 26%), respiratory distress syndrome (5% vs. 13%), and need for invasive ventilation (0% vs. 4%).
- ACS group also had reduced hyperbilirubinemia requiring phototherapy (24% vs. 39%) and overall respiratory morbidity (16% vs. 28%).
- No significant differences were observed in necrotizing enterocolitis, hypoglycemia, IVH, TTN, sepsis, or mortality.
Conclusions:
- Antenatal corticosteroids administered between 34 and 36 6/7 weeks gestation are effective in reducing respiratory morbidity.
- ACS significantly decrease the incidence of NICU admissions, respiratory distress syndrome, and the need for invasive ventilation.
- Treatment with ACS also lowers the rate of hyperbilirubinemia requiring phototherapy in late preterm infants.
Aim And Objective:
To determine the efficacy of antenatal corticosteroids given in the late preterm period.
Methodology:
We conducted a retrospective case-control study on patients with singleton pregnancies who were at a risk of delivering in the late preterm period (34 weeks to 36 weeks 6 days). A total of 126 patients who had received antenatal corticosteroids (prenatal administration of either betamethasone or dexamethasone, minimum one dose) during the late preterm period were taken as cases, and 135 patients who had not received steroids antenatally due to various reasons, for example, who were clinically unstable, presented with active bleeding, non-reassuring foetal status that obligated an imminent delivery and those in active labour were included as controls. The various neonatal outcomes like APGAR score at one and five minutes, incidence of admission and duration of stay in neonatal intensive care unit (NICU), respiratory morbidity, requirement of assisted ventilation, intraventricular haemorrhage (IVH) necrotizing enterocolitis, transient tachypnea of the newborn, respiratory distress syndrome, use of surfactant, neonatal hypoglycaemia, hyperbilirubinemia requiring phototherapy, sepsis and neonatal mortality were compared between the two groups.
Results:
The baseline characteristics of both groups were comparable. There was a lower incidence of admissions to neonatal intensive care unit (NICU) (15% vs. 26%, p = 0.05), respiratory distress syndrome (5% vs. 13%, p = 0.04), requirement of invasive ventilation (0% vs. 4%, p = 0.04) and hyperbilirubinemia requiring phototherapy (24% vs. 39%, p = 0.02) in the babies of the group that received steroids compared to the control group. The rate of overall respiratory morbidity in the neonates was lowered after giving steroids (16% vs. 28%, p = 0.04). The incidence of neonatal necrotizing enterocolitis, hypoglycaemia, IVH, TTN, sepsis and mortality between the two groups was not significant (p > 0.05).
Conclusion:
Antenatal corticosteroids administered to patients between 34 and 36 weeks 6 days of gestation reduce respiratory morbidity, requirement of invasive ventilation, respiratory distress syndrome, hyperbilirubinemia requiring phototherapy and the incidence of NICU admissions in the newborns.
Supplementary Information:
The online version contains supplementary material available at 10.1007/s13224-022-01664-5.
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