Am J Perinatol. 2021 Oct 20. doi: 10.1055/a-1674-6198. Online ahead of print.
ABSTRACT
OBJECTIVE: While administration of antenatal corticosteroids prior to term elective cesarean deliveries has been shown in international randomized controlled trials to decrease the rates of respiratory distress syndrome and transient tachypnea of the newborn, this is not standard practice in the United States. We aim to determine if administration of antenatal corticosteroids for fetal lung maturation within one week of scheduled early term cesarean delivery resulted in decreased composite respiratory morbidity.
STUDY DESIGN: Historical cohort study including women who underwent scheduled early term cesarean delivery of a singleton, non-anomalous neonate at Mount Sinai Hospital between May 2015 and August 2019, comparing those who completed a course of antenatal corticosteroids within one week of delivery to those who did not. The primary outcome was composite respiratory morbidity defined as respiratory distress syndrome, transient tachypnea of the newborn and NICU admission for respiratory morbidity. Maternal and neonatal characteristics were compared between groups using T-tests or Wilcoxon-Rank Sum tests for continuous measures and Chi-square or Fisher’s exact tests for categorical measures, as appropriate. The outcomes were assessed using logistic regression.
RESULTS: History of preterm birth was significantly higher in those who received antenatal corticosteroids compared to those who did not (24.0% vs. 10.9%, p=0.01). Neonates who were not exposed to antenatal corticosteroids were more likely to experience the composite respiratory morbidity compared to those who were exposed (RR 4.1, 95% CI 1.2-13.7; p=0.02). Between 37 and 38 weeks, neonates who did not receive steroids were at increased risk of composite respiratory morbidity (RR 11.7, 95% CI 1.5-89.0, p<0.01), however there was no difference for those born between 38 and 39 weeks.
CONCLUSION: Betamethasone course administered prior to planned early term cesarean delivery was associated with a statistically significant reduction in the neonatal composite respiratory morbidity compared to routine management.
PMID:34670323 | DOI:10.1055/a-1674-6198
