Antenatal dexamethasone for late preterm delivery: Rate of complete course and neonatal outcomes

This retrospective cohort study aimed to assess the rate of complete dexamethasone administration among late preterm deliveries and its impact on neonatal outcomes.

We reviewed medical records of 1500 late preterm deliveries (gestational age 34-36 + 6 weeks) between January 2018 and December 2020, analyzing baseline characteristics, dexamethasone administration, and pregnancy outcomes. Neonatal outcomes were evaluated separately for singletons and twins, comparing three groups: complete course, incomplete course, and no dexamethasone.

The overall rate of complete dexamethasone administration was 31.7%, varying between singletons (29.2%) and twins (48.4%). Singleton pregnancies receiving the complete course had significantly lower odds of Apgar scores <7 at 5 min compared with the incomplete course and no-dexamethasone groups (adjusted risk ratio [aRR] 0.22, 95% confidence interval [CI] 0.05-0.94 and 0.11, 95% CI 0.02-0.64, respectively). Complete course recipients also had reduced odds of apnea compared with the incomplete group (aRR 0.32, 95% CI 0.13-0.78). In twin pregnancies, neonatal sepsis incidence was lower in the complete course group than in the incomplete and no-dexamethasone groups (aRR 0.02, 95% CI 0.001-0.65 and 0.005, 95% CI 0.001-0.3, respectively). However, no significant differences were found in neonatal death or severe morbidity in singleton pregnancies. Neonatal sepsis was reduced in twins who received a complete course of dexamethasone.

Approximately one-third of late preterm pregnancies received a complete dexamethasone course. Although neonatal death and severe morbidity were similar across groups, the complete course group showed improved respiratory outcomes in singletons and lower neonatal sepsis incidence in twins. However, these findings should be interpreted with caution due to the limited sample size and wide confidence intervals, which indicate potential uncertainty in the estimates.