Effects of prenatal exposure to dexamethasone on early complications and survival outcome in the newborns with very and extremely low birth weight

Objective: To explore the effect of prenatal exposure to dexamethasone on early postnatal complications and survival outcomes in the newborns with very low and extremely low birth weight. Methods: The information of 355 infants born in the Obstetrics Department of the Lianyungang Hospital Affiliated to Xuzhou Medical University from Ja-nuary 1, 2012 to July 31, 2020 was collected and used to do a retrospective analysis. The newborns were transferred directly to the Department of Neonatal in the same hospital because of birth weight ≤1 500 g. The infants with very low(birth weight greater than 1 000 g and less than 1 500 g) and extremely low birth weight(birth weight<1 000 g） were divi-ded into the exposed and unexposed groups according to whether their mothers received or did not receive standard dexamethasone therapy before giving birth, and the survival outcomes and incidence of early complications were compared between the two groups. Based on the general data of 298 living premature infants, a univariate analysis and binary logistic regression were performed to analyzethe risk factors of earlycomplications. Results: In 326 infants with very low birth weight,the mortality rate of the exposed group was lower than that of the unexposed group (8.1% vs. 19.1%) ( χ2=6.774, P=0.009). The clinical data between the exposed and unexposed groups including gender, birth weight, gestational age, Apgar score, fetal number, delivery method, hospital stay, oxygen therapy time didn′t show statistically different (P>0.05). In addition, the early postnatal complications including the incidence of jaundice, neonatal anemia, neonatal pneumonia, necrotizing enterocolitis, patent ductus arteriosus and intraventricular hemorrhage were similar between the exposed and unexposed groups (P>0.05). The incidences of RDS (respiratory distress syndrome) and broncho-pulmonary dysplasia in the exposed group were lower than those in the unexposed group (24.5% vs. 37.9%, 19.6% vs. 31.0%, P<0.05), and prenatal use of dexamethasone was a protective factor for occurrences of RDS. However, the incidences of neonatal hypoglycemia, neonatal sepsis, and retinopathy of prematurity in the exposed group were higher than those in the unexposed group (P<0.05) in the infants with very low weight. The prenatal use of dexamethasone was an independent risk factor for occurrences of early complications mentioned above (OR values were 4.332, 2.813, 4.888, and 95%CI were 2.443-7.681, 1.316-6.014, 1.609-14.849, respectively).There was no statistical difference in the perinatal complication of pregnant women between the exposed group and the unexposed group (P>0.05). For extremely low birth weight infant,there was no significant difference in survival outcomes, general neonatal information, early postnatal complications, and maternal complications between exposed and unexposed groups. Conclusions: Prenatal use of dexamethasone has no effect on survival outcomes and early complications in the infants with extremely low birth weight. It could improve survival rate and prognosis in the infants with very low birth weight by reducing the occurrences of postnatal RDS and broncho-pulmonary dysplasias, while it may increase the incidences of retinopathy of prematurity, neonatal hypoglycemia and neonatal sepsis in them