The Associations between Antenatal Corticosteroids and In-Hospital Outcomes of Preterm Singleton Appropriate for Gestational Age Neonates according to the Presence of Maternal Histologic Chorioamnionitis

Abstract

Introduction: This study aimed to assess the association between antenatal corticosteroid (ACS) and in-hospital outcomes of preterm singleton appropriate for gestational age (AGA) infants according to the presence of maternal histologic chorioamnionitis (HCA). Methods: A retrospective study was performed with singleton AGA neonates of 23⁺⁰ to 33⁺⁶ weeks’ gestation born between 2007 and 2014. We compared the clinical outcomes according to the presence of HCA and ACS use. We also divided the ACS group into 2 groups: infants who received ACS 2–7 days before birth (optimal ACS) or not (suboptimal ACS). Multivariate logistic regression with Firth’s penalized likelihood was performed. Results: In total, 254 neonates were eligible with 109 neonates with HCA (42.9%). In multivariate analysis adjusting for GA, sex, and cesarean section, ACS use was associated with reduced severe bronchopulmonary dysplasia (BPD) or death and hypotension within 7 postnatal days among the neonates with HCA. However, it was associated with increased patent ductus arteriosus (PDA) treatment. In the optimal ACS group, severe BPD or death (aOR 0.03, 95% CI 0.01–0.42), hypotension (aOR 0.02, 95% CI 0.01–0.26), and inhaled nitric oxide use (aOR 0.06, 95% CI 0.00–0.81) were lower, however, PDA treatment (aOR 8.14, 95% CI 1.20–55.24) and sepsis (aOR 6.85, 95% CI 1.02–46.07) were higher when compared with the no ACS group among HCA+ infants. Among HCA– infants, only PDA treatment was lower in the ACS group. Conclusion: In neonates with HCA, ACS treatment was associated with reduced morbidities. However, increased sepsis was associated with optimal ACS use.