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Association between antenatal corticosteroid administration and neonatal hypoglycaemia in infants born at term: an observational cohort study
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  • Angelo Cavallaro,
  • Christos Ioannou,
  • Marta Garbagnati,
  • Talia Hubble,
  • Daniel Oros,
  • Lawrence Impey
Angelo Cavallaro
Oxford University Hospitals NHS Foundation Trust

Corresponding Author:[email protected]

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Christos Ioannou
Oxford University Hospitals NHS Foundation Trust
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Marta Garbagnati
Oxford University Hospitals NHS Foundation Trust
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Talia Hubble
Oxford University Hospitals NHS Foundation Trust
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Daniel Oros
Hospital Clinico Universitario Zaragoza, University of Zaragoza. Spain
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Lawrence Impey
Oxford University Hospitals NHS Foundation Trust
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Abstract

OBJECTIVE Assess whether antenatal corticosteroids for fetal lung maturation are associated with hypoglycaemia in neonates born at term. DESIGN Cohort study of term singleton deliveries over a 3-year period. SETTING Tertiary UK hospital. POPULATION The cohort includes neonates not exposed to corticosteroids; those exposed before 34 weeks because of suspected preterm birth but delivered at term (group 1); those exposed after 34 weeks because of anticipated late preterm birth (group 2); and - included in the latter - a subgroup of neonates exposed within 7 days of their actual delivery (group 2a). METHODS Retrospective analysis of the association between exposure and neonatal outcomes using multivariate regression to adjust for confounders. MAIN OUTCOME MEASURES Severe neonatal hypoglycaemia requiring admission to NNU; and need for ventilatory support. RESULTS Amongst 20102 eligible pregnancies, 143 women received corticosteroids before 34 weeks; and 187 after 34 weeks, of which 106 were within 7 days of delivery. Severe hypoglycaemia occurred in 227 neonates. Univariate predictors of hypoglycaemia were maternal BMI, nulliparity, hypertension, diabetes, gestation at birth, birthweight<10 centile and corticosteroid exposure. Following adjustment for covariates, corticosteroid exposure was independently associated with hypoglycaemia in all exposed groups: group 1 adjusted odds ratio (aOR) 3.26 (1.38-7.73); group 2 aOR 4.56 (2.47-8.42); and group 2a aOR 5.70 (2.49-13.03). Ventilatory support was not significantly different in any of the exposed groups. CONCLUSION There is increased risk of hypoglycaemia in neonates exposed to antenatal corticosteroids who are born at term. The risk of hypoglycaemia is higher with decreasing corticosteroid-to-birth interval.