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

Abstract

Objectives

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.

Methods

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).

Results

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.

Conclusion

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.

Keywords:

• Antenatal dexamethasone
• cortisol
• hypothalamic-pituitary-adrenal axis
• late preterm
• neonatal hypoglycemia

Acknowledgements

The authors would like to thank Dr. Buranee Yangthara for the statistical analysis and all the parents and infants who voluntarily participated in the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, RK, upon reasonable request.

Additional information

Funding

This research project was supported by the Siriraj research development fund, Grant Number (IO) R016531032 (Fund 3), Faculty of Medicine Siriraj Hospital, Mahidol University.