Factors associated with the development of neonatal hypoglycemia after antenatal corticosteroid administration: It's all about timing.

OBJECTIVE We aimed to determine the factors associated with neonatal hypoglycemia among neonates exposed to antenatal corticosteroid (ACS). METHODS A retrospective study conducted during 2017-2019 at a tertiary-care center including all neonates delivered between 24-34 weeks of gestation after ACS administration. The primary outcome was neonatal hypoglycemia (<40 mg/dL). RESULTS Overall, 362 early preterm neonates, including 205 singletons and 157 twins, were exposed to ACS prior to delivery and constituted the study group. Of them, 275 (76.0%) were exposed to a single ACS course and 87 (24.0%) to an additional rescue ACS course. Neonatal hypoglycemia occurred in 84 (23.2%) neonates. The incidence of neonatal hypoglycemia was significantly higher in those delivered between 24 to 48 hours after ACS administration as compared to those delivered outside of this time interval (10/25, 40.0% vs. 74/337, 21.9%, P=0.049). In multivariate analysis, after adjusting for neonatal birthweight and gestational age, delivery within 24-48 hours after ACS administration was found as the only independent risk factor associated with neonatal hypoglycemia (aOR [95% CI]: 2.41 (1.03, 5.68), P=0.044). CONCLUSION Neonatal hypoglycemia occurred in over one fifth of those exposed to ACS, and was independently associated with delivery between 24 to 48 hours after ACS administration.