Relationship of time interval between antenatal corticosteroid administrations to delivery with respiratory distress in preterm newborns

Objectives: To assess the relationship of time interval between antenatal corticosteroid administration and delivery with respiratory distress in premature newborns. Settings: Tertiary level teaching hospital Population: Preterm deliveries between 28 and 34 weeks in the period of April 2011 to January 2013 where the mothers received one course of corticosteroid prophylaxis and fulfilled the selection criteria. Materials and methods: Perusal of the hospital records was made to gather antenatal information and the details of delivery and the newborn. The patients were divided based on the number of doses of steroids received into three groups. The patients receiving complete steroid prophylaxis was further divided based on the time interval between steroid administration and delivery into five groups: 0 to 7 days, 8 to 14, 15 to 21, 22 to 28, 29 days and beyond. We looked for association between neonatal respiratory outcomes and steroid­delivery intervals using Statistical Package for the Social Sciences version 16 (SPSS, Chicago, USA). Regression model was used to control for the confounding variables. Results: There were 284 women who delivered preterm (up to 34 weeks of gestation) between April 2011 and January 2013 and fulfilled the selection criteria. The babies who received one (48) or no dose of steroids (14) had a higher incidence of respiratory distress than the ones who received a complete dose. This was statistically significant for babies born up to 32 weeks. Among the rest 222 babies who received complete steroid prophylaxis, 138 (62%) of the neonates born were admitted in NICU, respiratory distress was seen in 62 (28%). Eleven (5%) of the babies required intubation and 22 (9%) required surfactant therapy; there were 12 (5%) neonatal deaths. Multivariable logistic regression analysis showed a slightly increased risk of respiratory morbidity with increased interval from administration to delivery (OR–0.87 for 8–14 days, 1.79 for 15–21 days and 0.16 for 22–28 days). Conclusion: The risk of respiratory distress in preterm newborns increases beyond 2 weeks interval between antenatal corticosteroid administration and delivery.