Efficacy and safety of antenatal corticosteroids on preterm neonatal outcomes in a semi-urban low-resource setting: A retrospective cohort study

Abstract

Background: Preterm birth is a leading cause of neonatal morbidity and mortality, particularly in low-resource settings where neonatal intensive care support is limited. Antenatal corticosteroids (ACS) have been shown to improve outcomes in preterm neonates, but their implementation and impact in resource-constrained environments remain inadequately studied. Materials and Methods: This retrospective observational cohort study was conducted at a tertiary care hospital in Puducherry, India, from January to December 2018. Pregnant women delivering between 28 and 34 weeks gestation were included and divided into two groups: those who received ACS (n=138) and those who did not (n=74). Neonatal and maternal outcomes were compared using standard statistical methods. Logistic regression was performed to identify independent predictors of neonatal mortality. Results: Neonates in the ACS group had significantly higher mean birth weight (1825 ± 210 g vs 1650 ± 230 g, p<0.001), improved 5-minute Apgar scores (7.4 ± 1.2 vs 6.2 ± 1.5, p<0.001), and reduced NICU admissions (34.8% vs 55.4%, p=0.004) and neonatal mortality (3.6% vs 14.9%, p=0.002). The incidence of RDS, IVH, and NEC were significantly lower in the ACS group. Multivariate analysis revealed that lack of ACS use was an independent predictor of neonatal mortality (OR 4.52, 95% CI: 1.67-12.26, p=0.003). Conclusion: Antenatal corticosteroids significantly reduce neonatal morbidity and mortality among preterm infants even in low-resource settings. Incorporating ACS into standard preterm labor protocols could improve survival and reduce complications in such environments.