Role of antenatal steroids in respiratory distress in late preterm

Abstract

Background & Objectives: The current study was conducted to evaluate the utility of using steroids in mothers delivering between 34 to 36 weeks of gestational age (late preterm births) and neonatal outcomes such as need for resuscitation, NICU admission, APGAR scores, need for interventions such as oxygen supplementation, CPAP and mechanical ventilation. In addition, neonatal morbidity was also evaluated. Methodology: The study was double group, randomized study with interventional group (study group) and the comparator (control group) comprising of 100 patients each. The patients were randomly assigned to either of the group, however in case the delivery was inevitable before giving steroid injection the patients were invariably assigned to the control group. The steroid injections comprised of either dexamethasone 4 doses or betamethasone with a maximum of 2 doses given in the study group. Due consent was obtained from the patients satisfying the inclusion criteria of age above 18 years. Results: The mean gestational age in the interventional group was 34.58 weeks (SD:0.77) compared to 34.39 weeks (0.61) in the control group with a P value of 0.055 signifying a non-significant difference. The mean APGAR score at 1 minute was 5.35 in study group (SD:1.1) compared to 5.01 in control group (SD:1.23). 26 neonates in study group required resuscitative measures compared to 40 in the control group. 11 subjects each in study group developed transient tachypnoea of new born (TTNB) and Hyaline membrane disease whereas in control group there were 12 neonates with TTNB and 32 with Hyaline membrane disease. The difference was significant with a significantly higher incidence of hyaline membrane disease in control with P value of 0.0422. 5 males each and 6 females each had TTNB in study and control group respectively whereas 7 and 19 males had HMD, and 4 and 14 females had HMD in study and control group respectively. The difference was non- significant with P value of 1 for TTNB and significant with P value of 0.003 for HMD respectively, showing an increased incidence for HMD in male gender in control group. 15 neonates in study group required NICU admission compared to 27 in the control group. 7 neonates in study group required mechanical ventilation compared to 17 in the control group. 12 neonates in study group required oxygen supplementation compared to 23 in the control group. 22 neonates in study group required some or other intervention compared to 44 in the control group. 4 neonates in study group died compared to 12 in the control group. Conclusion: Steroids injections of either betamethasone or dexamethasone given to mothers expecting a preterm delivery between 34 to 36 weeks may have a beneficial effect on neonatal outcomes especially the respiratory parameters. We suggest use of antenatal steroids in prior to expected preterm births based on finding of our study.