INTRODUCTION
The antenatal administration of high dose corticosteroids for neonates born before 34 weeks is a key priority in maternity and neonatal practice 1-4. Clear benefits in perinatal death and serious morbidity are reported 2.
Most exposed neonates, however, are born after 34 weeks; many at term5, as the prediction of preterm labour is so imprecise6. Further, the upper gestation at which antenatal corticosteroids (ACS) are commonly given has increased. Several guidelines 1-4 and trials recommend ACS after 34 weeks7-9, and even prior to caesarean section at early term gestation 10-12 due to the latter’s association with neonatal respiratory complications 13.
These policies are controversial and not universal 4. As birth at later gestation is more common and the consequences of prematurity less severe, any capacity for corticosteroid-related harm is correspondingly greater. ACS appear to increase the risk of neonatal hypoglycaemia 8, 14. Where severe, this is a common cause of term neonatal unit admission 15 and has been associated with long term neurological deficit 16. As most corticosteroid trials focus on participant outcomes before term8 or have not assessed hypoglycaemia10, 11, good data in term neonates is lacking.
The aim of this study was to assess the association between antenatal corticosteroid administration and severe hypoglycaemia in neonates born at term. The analysis addresses two groups: 1) those exposed before 34 weeks because of a perceived risk of severe preterm birth but subsequently deliver at term; and 2) those exposed after 34 weeks because of anticipated late preterm or early term birth.