Effect of antenatal corticosteroids on neonatal outcomes following elective caesarean section at term: A retrospective study

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Background: Elective caesarean section at term, performed in the absence of labour, is associated with increased risk of neonatal respiratory morbidity due to impaired lung fluid clearance. Antenatal corticosteroid administration has been proposed to mitigate this risk, but evidence regarding its efficacy in term neonates remains inconclusive. Objectives: To evaluate the effect of antenatal corticosteroid administration on neonatal outcomes, including resuscitation requirements, Apgar scores, and neonatal unit admissions, in term neonates delivered by elective caesarean section. Material and Methods: A retrospective study was conducted on 700 term neonates (?37 weeks gestation) delivered by planned lower segment caesarean section (LSCS). The study group (n=350) comprised neonates whose mothers received antenatal corticosteroids prior to delivery, while the control group (n=350) did not receive corticosteroids. Primary outcomes measured included need for resuscitation (bag-and-mask ventilation and endotracheal intubation), Apgar scores at 1 and 5 minutes, admission to Special Baby Care Unit (SBCU), and requirement for Neonatal Intensive Care Unit (NICU) care. Incidence and relative risk (RR) were calculated to assess outcomes. Results: The study and control groups were comparable with respect to maternal age (30 vs. 30.5 years), neonatal sex distribution (male 54.3% vs. 52.3%), birth weight (3200 g vs. 3274 g), and amniotic fluid characteristics (clear 92% vs. 91%). The corticosteroid group demonstrated lower incidence across all measured outcomes: bag-and-mask resuscitation (6.6% vs. 9.7%, P=0.129), endotracheal intubation (0.9% vs. 2.3%, P=0.224), 1-minute Apgar score <8 (6.9% vs. 10.3%, P=0.105), 5-minute Apgar score <8 (5.4% vs. 9.1%, P=0.059), SBCU admission (3.1% vs. 6.9%, P=0.024), and NICU care requirement (1.4% vs. 3.4%, P=0.086). SBCU admission was the only outcome achieving statistical significance. Conclusion: Antenatal corticosteroid administration was associated with a statistically significant reduction in SBCU admission among term neonates delivered by elective caesarean section. While all other neonatal outcomes exhibited a favourable trend in the corticosteroid group, they did not attain statistical significance, suggesting a potential benefit that warrants further investigation through larger, multi-centre randomised controlled trials.

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