Nephrotoxic versus nephroprotective: What is the role of antenatal steroids in preterm neonates

BackgroundAntenatal corticosteroids (ANS) enhance pulmonary maturation in preterm neonates, but their renal effects remain incompletely understood. This study evaluated the association ANS exposure with the prevalence and severity of acute kidney injury (AKI) in preterm neonates.MethodologyThis prospective cross-sectional study was conducted in NICU, Fatima Memorial Hospital, Shadman, Lahore, Pakistan from March 2023 to January 2025. It included 399 preterm neonates of 28-36 + 6 weeks gestation. Neonates were categorized based on antenatal steroids exposure as complete, incomplete, or no ANS groups. AKI was defined and staged according to KDIGO criteria during the first 14 days of life. All variables in descriptive statistics with p < 0.05 incorporated into multivariate logistic regression. The model fit was assessed using Hosmer-Lemeshow test.ResultsOf 399 neonates, 64 (16%) of neonates received a complete ANS course, 51.4% incomplete, and 32.6% none. The incidence of AKI was significantly lower in the complete ANS group compared with the incomplete and no-ANS groups (23.4% vs 47.3% and 45.4%, respectively (p = 0.003). On multivariate analysis, complete ANS remained an independent protective factor (p = 0.006, AOR 0.33, 95% CI 0.15-0.73) reducing the odds of renal failure by approximately 63%.ConclusionComplete antenatal steroid (ANS) exposure in preterm neonates was associated with lower incidence and severity of acute kidney injury, with multivariate analysis confirming reduced odds of AKI.