Abstract
Objective
Compared to term infants, late preterm infants have a higher risk of morbidity. Betamethasone
(BMZ) has been shown to decrease neonatal respiratory distress but has been associated
with neonatal hypoglycemia. This study sought to determine clinical risk factors for
neonatal hypoglycemia after administration of antenatal late preterm steroids (ALPS).
A secondary analysis was performed to assess outcomes associated with a partial course
of ALPS.
Study Design
This was a retrospective study of pregnant patients who delivered between 340/7 and 366/7 weeks of gestational age from October 2017 to September 2020 at our tertiary care
medical center and who received one or two doses of ALPS. We excluded patients who
had received prior treatment with BMZ, those with pregestational diabetes, a known
anomalous fetus, or multifetal gestation. Neonatal hypoglycemia was defined as <30 mg/dL
in the first 24 hours and <45 mg/dL after the first 24 hours of life.
Results
About 239 patients met our inclusion criteria. Incidence of neonatal hypoglycemia
increased with increasing birthing parent age, with cesarean delivery, and in those
who delivered after the onset of labor, regardless of gestational age at delivery.
Deliveries that occurred less than 48 hours after the first BMZ dose were more likely
to have neonatal hypoglycemia and neonatal intensive care unit (NICU) admission. In
an adjusted model, the incidence of hypoglycemia was the highest from 12 to 35 hours
after first BMZ exposure.
Conclusion
In patients who delivered prior to a complete course of ALPS, there were higher rates
of neonatal hypoglycemia and NICU admissions. In our cohort, hypoglycemia occurred
most often when delivery occurred between 12 and 35 hours after BMZ administration.
This information may aid in decision-making on whether to offer ALPS to patients who
are at higher risk of delivery in less than 48 hours and in postnatal care for neonates
exposed to ALPS.
Key Points
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Shorter ALPS exposure to delivery time had increased odds of neonatal hypoglycemia.
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Shorter ALPS exposure to delivery time had increased odds of NICU admission.
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Delivery 12 to 35 hours after ALPS was associated with the highest risk of neonatal
hypoglycemia.
Keywords
late preterm - ALPS - steroids - betamethasone - neonatal hypoglycemia
