604 Clinical indications for antenatal late preterm steroids affect neonatal hypoglycemia

Abstract

Antenatal Late Prenatal Steroids (ALPS) may reduce the incidence of neonatal respiratory disorders, though exposure is associated with higher rates of hypoglycemia. Our objective was to evaluate the relationship between clinical factors surrounding use of ALPS and the incidence of neonatal hypoglycemia. A retrospective chart review of records identified patients who received ALPS and all late preterm deliveries (LPTD) at 34 0/7-34 6/7 weeks from 2017 to 2019. Clinical and demographic information was obtained. Neonatal hypoglycemia was defined as point-of-care glucose <40mg/dL during admission. Pregnancies with and without neonatal hypoglycemia were compared using Student t test, and Fisher’s exact test. A p-value <0.05 was considered statistically significant. We identified 272 patients who received ALPS. Of those, 146 (53.7%) received it due to risk of indicated preterm birth and 126 (46.3%) due to risk of spontaneous preterm birth. The rate of preterm delivery was 57.4%. In those delivering at <37 weeks, 78.2% delivered within 48-hours. Hypoglycemia was diagnosed in 71 newborns (26.1%), and was more common in preterm vs. term births (37.2% vs. 11.2%; p<.001). Table 1 compares the cohorts of preterm births with and without neonatal hypoglycemia. Gestational age at delivery and birthweights were similar. Rates of neonatal hypoglycemia were increased when delivery occurred ≥48-hours after the first-dose of steroids (31.0% vs. 16.3%; p=0.04). Hypoglycemia was less common in preterm births who delivered within 48-hours of ALPS (32.8% vs. 52.9%; p=0.04). Neonatal respiratory disorders (RDS or TTN) were more common in those delivering within 48-hours (33.6% vs. 14.7%; p=0.04) compared to those who delivered ≥48-hours after first-dose. In those receiving ALPS, hypoglycemia was common in late preterm births. The highest rate was in preterm births >48-hours after administration of first-dose. As this corresponded to lower rates of neonatal respiratory disorders, the risk and benefit of ALPS appear to coincide in this group of patients.