The effect of antenatal corticosteroids on small-for-gestational age preterm neonates

Abstract

Objective: Treatment of preterm small-for-gestational age (SGA) neonates with antenatal corticosteroids (ACS) is not entirely straightforward. We sought to examine the effect of a full course of ACS on outcomes of SGA and non-SGA preterm singletons.

Patients and methods: We compared maternal characteristics and outcomes of preterm births at <28 and 28 + 0-33 + 0 weeks' gestation that received a complete course of ACS within a week before birth. We further divided our cohort into those with or without a SGA neonate.

Results: We included 290 infants: 73 (25.2%) and 217 (74.8%) born at <28 and 28 + 0-33 + 0 weeks' gestation, respectively. Analysis of maternal characteristics showed a strong association of maternal body mass index (p = .01), along with smoking during pregnancy (OR 0.4, 95% CI 0.2, 0.9), with being SGA. Spontaneous onset of delivery more commonly occurred in non-SGA preterm neonates, whereas iatrogenic induction of labor prevailed with SGA neonates (p < .01). There was no significant difference between SGA and non-SGA infants in all the tested neonatal variables except for necrotizing enterocolitis, which prevailed in the SGA group.

Conclusion: A full course of ACS appears to have the same effect in SGA and non-SGA preterm singletons in our studied cohort on all neonatal outcomes but for necrotizing enterocolitis, where its role in SGA preterm neonates seems to be detrimental rather than beneficial to the fetus.

Keywords: Antenatal corticosteroids; prematurity-related neonatal outcomes; preterm birth; small for gestational age; threatened preterm delivery.