Antenatal corticosteroid exposure in term infants and neonatal respiratory failure: A population based cohort study

Antenatal corticosteroids (ACS) exposure in term infants potentially cause short and long-term negative consequence. This study aims to estimate the prevalence of ACS exposure among term infants, identify associated risk factors, and assess the impact on neonatal respiratory failure (NRF).

A population-based, retrospective cohort analysis was conducted using the 2022 National Vital Statistics System data from USA, focusing on term infants (37-41 weeks' gestation). We defined ACS exposure based on any record of corticosteroid administration to the mother before delivery. Logistic regression models analyzed the risk factors of ACS exposure while propensity score matching(PSM) were used to evaluate the association between ACS exposure and NRF.

Of the 2,883,280 term infants studied, 34,986 (1.2 %) were exposed to ACS. Logistic regression model demonstrated that factors significantly linked to ACS exposure (adjusted Odds Ratios, aORs > 2) included multiple gestation (aOR 2.36, 95 % CI 2.26-2.46), lower gestational age (37 weeks vs. 39 weeks, aOR 3.92, 95 % CI 3.81-4.04), and SGA status (aOR 3.72, 95 % CI 3.63-3.81). After PSM, ACS-exposed infants exhibited a higher risk of NRF compared to non-exposed infants (3.9 % vs. 1.6 %; OR 2.58, 95 % CI 2.34-2.85; p < 0.001). Subgroup analyses demonstrated a consistent elevation of NRF risk associated with ACS exposure across various gestational ages, delivery methods, and maternal health conditions.

ACS exposure occurs in a notable percentage of term births and is associated with increased risks of NRF, challenging the primary objective of ACS use in term infants. The findings underline the need for more cautious and targeted administration of ACS to avoid unnecessary exposure and mitigate adverse outcomes in term infants.