Effect of Timing of Administration of Corticosteroids on Preterm Delivery and Neonatal Outcome

Abstract

Background: Preterm birth is a leading cause of neonatal morbidity and mortality, and while antenatal corticosteroids (ACS) are widely used to enhance fetal lung maturity, the optimal timing of their administration remains uncertain in low-resource settings. Objective: To assess the impact of corticosteroid-to-delivery intervals on neonatal outcomes—specifically respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and neonatal mortality—among women at risk of preterm birth. Methods: This descriptive case series was conducted at CMH Gujranwala from 1 January to 2 April 2025, involving 100 high-risk pregnant women aged 18–40 years, at 27+0 to 36+0 weeks gestation. Corticosteroid timing was grouped into ?2, 2–7, 7–14, and >14 days before delivery. Outcomes were clinically assessed using standardized diagnostic protocols. Ethical approval was obtained, and informed consent secured. Data were analyzed in SPSS v25 using chi-square tests and logistic regression. Results: Although RDS occurred in all neonates (100%), the incidence of NEC was highest in the 7–14 day group (73.7%), followed by 2–7 days (60.0%), >14 days (45.5%), and ?2 days (35.0%). Logistic regression showed a significantly higher risk of NEC in the 7–14 day group (adjusted OR = 5.60; 95% CI: 1.49–21.09; p = 0.010) compared to ?2 days. BPD was more prevalent in the >14 day group (45.5%). No statistically significant associations were observed for IVH (p = 0.612) or neonatal mortality (p = 0.994). Conclusion: While corticosteroid administration remains crucial in preterm birth management, timing beyond 7 days may increase the risk of complications like NEC. Improved prediction of preterm labor and individualized timing strategies may enhance neonatal outcomes in resource-limited settings.