Comparison of single versus multiple doses of antenatal corticosteroid administration on neonatal mortality and morbidity: a prospective observational study

Surya Guhan; Saravanan; Ilangumaran; Ummugulthoom

doi:10.18203/2349-3291.ijcp20263256

Authors

Surya Guhan Department of Paediatrics, Government Medical College and Hospital, Cuddalore, Chidambaram, Tamil Nadu, India
Saravanan Department of Paediatrics, Government Medical College and Hospital, Cuddalore, Chidambaram, Tamil Nadu, India
Ilangumaran Department of Paediatrics, Government Medical College and Hospital, Cuddalore, Chidambaram, Tamil Nadu, India
Ummugulthoom Department of Paediatrics, Government Medical College and Hospital, Cuddalore, Chidambaram, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20263256

Keywords:

Antenatal corticosteroids, Dexamethasone, Preterm birth, Neonatal mortality, Respiratory distress syndrome, Multiple doses

Abstract

Background: Antenatal corticosteroids (ACS) reduce respiratory and other complications of prematurity, but the comparative benefit of a single versus a complete multiple-dose course in real-world, resource-limited settings is not well defined. Objectives were to compare the effect of single versus multiple doses of antenatal dexamethasone on neonatal mortality and morbidity among preterm neonates delivered between 24 and 34 weeks of gestation.

Methods: This prospective observational study was conducted over 18 months in the neonatal intensive care unit (NICU), Department of Paediatrics, Government Medical College and Hospital, Cuddalore. Two hundred preterm neonates (24-34 weeks) were enrolled by convenience sampling and stratified into five groups by antenatal dexamethasone exposure: no dose, one, two, three, or four doses. Maternal and neonatal variables were recorded on a structured proforma. Categorical data were analysed with the chi-square test and continuous data with one-way ANOVA/Student’s t-test; multivariate logistic regression identified independent predictors of mortality. P<0.05 was considered significant.

Results: Groups were comparable for maternal age, comorbidities, gestational age, sex and mode of delivery (all p>0.05). Mean birth weight rose from 1385±310 g (no dose) to 1722±238 g (four doses, p<0.001), and 1- and 5-minute APGAR scores improved progressively (p<0.001). Respiratory distress syndrome (RDS) fell from 60.0% to 13.5% (p<0.001), intraventricular haemorrhage (IVH) from 20.0% to 3.8% (p=0.042), necrotising enterocolitis (NEC) from 16.7% to 1.9% (p=0.038), and overall neonatal sepsis from 33.3% to 7.7% (p=0.019). Requirement for CPAP, mechanical ventilation and surfactant, NICU admission and length of NICU stay all declined significantly with increasing dose (p<0.05). Neonatal mortality fell from 20.0% to 3.8% (p=0.043). Hypoglycaemia was more frequent with increasing exposure (16.7% to 25.0%, p=0.042). On multivariate analysis, gestational age <30 weeks (OR 3.24), birth weight <1500 g (OR 2.89), incomplete steroid exposure ≤2 doses (OR 2.52), RDS (OR 2.31), neonatal sepsis (OR 3.76) and IVH (OR 2.14) independently predicted mortality.

Conclusions: Completion of the recommended four-dose antenatal dexamethasone course was associated with a graded, significant reduction in neonatal mortality and major morbidity compared with partial or no exposure. Ensuring timely completion of the full ACS course in women at risk of preterm birth should be prioritised in clinical practice.

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