Comparative analysis on the efficacy of antenatal corticosteroids in preterm newborns in a Kazakhstani Tertiary Care Hospital setting.

Background: For over half a century, the administration of maternal corticosteroids before anticipated preterm birth has been regarded as a cornerstone intervention for enhancing neonatal outcomes, particularly in preventing respiratory distress syndrome. Ongoing research on antenatal corticosteroids (ACS) is continuously refining the evidence regarding their efficacy and potential side effects, which may alter the application of this treatment. Recent findings indicate that in resource-limited settings, the effectiveness of ACS is contingent upon meeting specific conditions, including providing adequate medical support for preterm newborns. Future studies are expected to concentrate on developing evidence-based strategies to safely enhance ACS utilization in low- and middle-income countries.

Aim: To analyze the clinical effectiveness of antenatal corticosteroids in improving outcomes for preterm newborns in a tertiary care hospital setting in Kazakhstan, following current World Health Organization guidelines.

Methods: This study employs a comparative retrospective cohort design to analyze single-center clinical data collected from January 2022 to February 2024. A total of 152 medical records of preterm newborns with gestational ages between 24 and 34 weeks were reviewed, focusing on the completeness of the ACS received. Quantitative variables are presented as means with standard deviations, while frequency analysis of qualitative indicators was performed using Pearson's χ ² test (χ²) and Fisher's exact test. If statistical significance was identified, pairwise comparisons between the three observation groups were conducted using the Bonferroni correction.

Results: The obtained data indicate that the complete implementation of antenatal steroid prophylaxis (ASP) improves neonatal outcomes, particularly by reducing the frequency of birth asphyxia (P = 0.002), the need for primary resuscitation (P = 0.002), the use of nasal continuous positive airway pressure (P = 0.022), and the need for surfactant replacement therapy (P = 0.038) compared to groups with incomplete or no ASP. Furthermore, complete ASP contributed to a decrease in morbidity among preterm newborns (e.g., respiratory distress syndrome, intrauterine pneumonia, cerebral ischemia, bronchopulmonary dysplasia, etc.), improved Apgar scores, and reduced the need for re-intubation and the frequency of mechanical ventilation. However, it was associated with an increased incidence of uterine atony in postpartum women (P = 0.0095).

Conclusion: In a tertiary hospital setting, the implementation of ACS therapy for pregnancies between 24 and 34 weeks of gestation at high risk for preterm birth significantly reduces the incidence of neonatal complications and related interventions. This, in turn, contributes to better outcomes for this cohort of children. However, the impact of ACS on maternal outcomes requires further thorough investigation.