Study Of Antenatal Corticosteroids With Early Postnatal Glucose And Birth Outcome In Twin Pregnancies

Objective:To investigate the effect of antenatal corticosteroids（ACS）application in twin pregnancies on early postnatal blood glucose level and birth outcomes in preterm infants.Methods:Preterm twin-born infants with gestational age of 29-34⁺⁶weeks admitted to our neonatal intensive care unit within 1 hour after birth from January 2020to December 2022 were selected for a retrospective study.According to whether ACS was applied prenatally,they were divided into the ACS non-application group and the ACS application group;according to the time interval between the last 1 dose of ACS application and delivery,they were divided into the<24h group,24h-7d group,and>7d group separately.The general data of the maternal and preterm infants were collected,and the postnatal 1h,4h,7h,24h and 48h terminal blood glucose level（BGL）,intravenous glucose infusion rate（GIR）,feeding condition and the occurrence of preterm birth-related diseases were collected.SPSS26.0 statistical software was applied to analyze the data,and P<0.05 indicated that the differences were statistically significant.Results:A total of 218 cases of twin preterm infants were included in this study,and the results were as follows.（1）There were 22 cases in the ACS non-application group and 196 cases in the ACS application group,and the application rate of ACS in twin pregnancies was 94.2%.（2）The BGL of twin preterm infants after birth dropped to the lowest level within1h,and then gradually increased from 4-7h,and the BGL gradually leveled off after 24h.The fluctuation of blood glucose level in the early postnatal period was affected by the gestational age of preterm infants,and the smaller the gestational age,the greater the fluctuation of blood glucose in the early postnatal period.（3）In the ACS application group,while the gestational age at birth was younger in preterm infants,and the difference was statistically significant compared with the ACS non-application group（P<0.05）.The differences between the two groups in the maternal age,the proportion of assisted reproduction,the mode of delivery,premature rupture of membranes,gestational hypertension,placental abruption,gestational hyperglycemia,prenatal BMI of the parturients,histological chorioamnionitis,sex of the preterm infant,birth weight,Apgar score,terminal BGL at 1h,4h,7h,24h,48h after birth,early postnatal GIR,transitional hypoglycemia,symptomatic hypoglycemia,severe hypoglycemia,preterm infant diseases that including neonatal respiratory distress syndrome（NRDS）,bronchopulmonary dysplasia（BPD）,neonatal pneumonia,transient tachypnea of the newborn（TTN）,neonatal sepsis,intraventricular hemorrhage（IVH）,necrotizing enterocolitis（NEC）,and length of stay in hospital for preterm infants were not statistically different（P>0.05）.（4）According to the time interval between the last dose of ACS application and delivery,among the subgroups<24h group（66 cases）,24h-7d group（66 cases）,and>7d group（64 cases）,there were no statistical differences in the incidence of NRDS,BPD,neonatal pneumonia,TTN,neonatal sepsis,NEC,IVH,and severe hypoglycemia separately.The differences among the three groups were statistically significant（P<0.05）in gestational age,length of hospital stay,time to breastfeeding,4h and 7h postnatal GIR,and 1h,4h,and 7h postnatal BGL.In the pairwise analysis of statistically different results,the 24h-7d group had lower postnatal 1h,4h,and 7h BGL and higher postnatal 4 and 7h GIR in twin preterm infants compared with the<24h group;the24h-7d group started breast milk later than the<24h and>7d groups;the<24h group had a statistically significant difference compared with the>7d group in terms of younger gestational age and longer hospital stay（P<0.05）.The incidence of transitional hypoglycemia and symptomatic hypoglycemia was higher in the 24h-7d group,and the difference was statistically significant（P<0.05）.（5）Multi-factor logistic regression analysis showed that maternal age,pregnancy mode,maternal prenatal BMI,preterm birth gestational age,birth weight,and 5-minute Apgar score were not risk factors for the occurrence of transitional hypoglycemia and symptomatic hypoglycemia in twin preterm infants in the early postnatal period.Conclusion:ACS application in twin pregnancies resulted in an increased risk of hypoglycemia in preterm infants within first 24h delivery time,but did not significantly improve the incidence of preterm birth-related complications,including NRDS,BPD,TTN,neonatal pneumonia,NEC,neonatal sepsis,and IVH.The time interval between the last dose of ACS application and delivery was not associated with birth outcome in twin preterm infants,but early postnatal BGL in twin preterm infants was affected by the time between the last dose of ACS and delivery and was self-limiting.