Effects of antenatal dexamethasone on postnatal serum cortisol levels in late preterm infants

• Published in: The journal of maternal-fetal & neonatal medicine Vol. 36; no. 2; p. 2224491
• Main Authors: Amawat, Jutharat, Wirayannawat, Wariphan, Boonyanunt, Pakamas, Paes, Bosco, Kitsommart, Ratchada
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 15.12.2023
• Subjects: Antenatal dexamethasone; cortisol; hypothalamic-pituitary-adrenal axis; late preterm; neonatal hypoglycemia; cortisol; hypothalamic-pituitary-adrenal axis; late preterm; Antenatal dexamethasone; neonatal hypoglycemia
• ISSN: 1476-7058; 1476-4954
• DOI: 10.1080/14767058.2023.2224491

To explore whether antenatal dexamethasone impacts postnatal serum cortisol levels in stable late preterm (LPT) infants. Secondary outcomes were to identify short-term hospital outcomes related to antenatal dexamethasone exposure. A prospective cohort study of serial serum cortisol levels in LPT infants within 3 h of birth, and at 1, 3, and 14 postnatal days. Serum cortisol levels were compared between infants exposed to antenatal dexamethasone >3 h and <14 days prior to delivery (aDex) and those who either did not receive dexamethasone or were exposed < 3 h or >14 days prior to delivery (no-aDex). Thirty-two LPT infants (aDex) were compared with 29 infants (no-aDEX). Group demographic characteristics were similar. Serum cortisol levels were identical between the groups at all 4-time points. Cumulative antenatal dexamethasone exposure ranged from 0 to 12 doses. Post-hoc analysis of the 24-hour serum cortisol levels indicated a significant difference between 1 to 3 cumulative doses versus 4 or more doses (p = .01). Only 1 infant in the aDex group had a cortisol level <3 rd percentile of the reference value. Rates of hypoglycemia (absolute difference [95% CI] − 1.0 [-16.0,15.0]; p = .90) and mechanical ventilation were similar in both groups (absolute difference [95%CI] − 0.3 [-9.3,8.7]; p = .94). No deaths occurred. Antenatal dexamethasone administered 14 days prior to delivery did not affect serum cortisol levels and short-term hospital outcomes in stable LPT infants. Exposure to low cumulative doses of dexamethasone resulted in transient low serum cortisol levels compared to 4 or more doses only at 24-hours.