The burden of preterm birth remains a global challenge, with respiratory distress syndrome serving as a primary driver of neonatal mortality and long-term morbidity. While the benefits of antenatal corticosteroids (ACS) have been historically documented, evolving neonatal resuscitation techniques and the increased use of non-invasive ventilation necessitate updated data to validate current protocols. This study addresses a critical gap by providing contemporary evidence on the magnitude of ACS benefit in a modern ICU setting. Understanding the quantitative reduction in surfactant demand and ventilation duration is essential for hospital resource planning and risk counseling for expectant parents. By refining the evidence base for ACS efficacy, this research supports the optimization of maternal-fetal care pathways, potentially reducing the length of neonatal stay and improving the overall neurodevelopmental trajectory of the preterm population.
To evaluate the clinical efficacy of complete antenatal corticosteroid courses in reducing the incidence and severity of neonatal respiratory distress syndrome and associated morbidities in preterm infants.
A retrospective multicenter cohort study was conducted involving 842 pregnant women at risk of preterm delivery (24–34 weeks GA) across three tertiary referral centers between 2020 and 2023. Participants were categorized into two groups: the Treatment Group (n=518), who received a complete course of betamethasone (two 12-mg doses 24 hours apart), and the Control Group (n=324), who received no steroids or an incomplete course. Neonatal outcomes were tracked through electronic health records, focusing on the diagnosis of RDS based on clinical and radiographic criteria. Secondary outcomes included the need for exogenous surfactant, duration of invasive mechanical ventilation, and the incidence of necrotizing enterocolitis. Statistical analysis was performed using multivariate logistic regression to adjust for gestational age at birth, maternal comorbidities, and mode of delivery. A p-value of <0.05 was considered statistically significant, with 95% confidence intervals calculated for all primary outcome measures.
A total of 842 infants were analyzed (mean GA 29.4 ± 2.1 weeks). The incidence of RDS was significantly lower in the Treatement Group compared to the Control Group (38.2% vs. 56.5%; OR 0.48; 95% CI 0.36–0.64; p<0.001). Infants in the ACS group required exogenous surfactant therapy at a lower rate (24.1% vs. 41.2%; p<0.01) and exhibited a shorter median duration of mechanical ventilation (3.2 days vs. 6.8 days; p<0.005). Furthermore, the incidence of severe (Grade III/IV) intraventricular hemorrhage was reduced by 44% in the steroid-exposed group (4.8% vs. 8.6%; OR 0.56; 95% CI 0.32–0.98). Subgroup analysis indicated that the greatest reduction in RDS occurred when the interval between the first dose and delivery was 48 hours to 7 days. No significant difference was observed in the rates of maternal sepsis between the two cohorts (2.1% vs. 1.9%; p=0.82), confirming the safety profile of the intervention.
Antenatal corticosteroids significantly reduce the burden of neonatal respiratory distress syndrome and its associated complications in infants born before 34 weeks of gestation. The marked reduction in surfactant requirements and the lower incidence of severe IVH confirm that ACS remains a vital intervention in perinatology. Furthermore, the data suggests that the maximal therapeutic benefit is time-sensitive, occurring when delivery occurs within the first week of administration. These findings support the continued prioritization of ACS administration in suspected preterm labor. Future research should focus on optimizing the 'rescue dose' protocols and long-term neurodevelopmental outcomes to further refine these clinical guidelines, ensuring that the benefits of steroid exposure are maximized while minimizing potential over-utilization in late-preterm scenarios.