Question 51

Neonatal hypoglycaemia is an important recognised short-term adverse effect when antenatal corticosteroids are administered in the late-preterm period. In the major late-preterm trial, corticosteroid administration reduced the requirement for respiratory support during the first 72 hours of life, but neonatal hypoglycaemia occurred more frequently in the corticosteroid group. The reported rates were 24.0% following betamethasone compared with 15.0% with placebo. This illustrates why treatment between 35+0 and 36+6 weeks should not be regarded as an automatic intervention. Instead, clinicians and women should consider the balance between potential respiratory benefit and the increased likelihood of neonatal hypoglycaemia. Babies exposed to corticosteroids in this setting should receive appropriate neonatal assessment and management for hypoglycaemia according to standard practice. Hypercalcaemia, persistent hypertension, polycythaemia and congenital hypothyroidism are not the important short-term trade-off associated with late-preterm corticosteroid administration.

A) Neonatal hypercalcaemia is not the principal short-term adverse effect highlighted for late-preterm antenatal corticosteroid exposure.

C) Persistent neonatal hypertension is not the recognised adverse effect that drives late-preterm corticosteroid counselling.

D) Neonatal polycythaemia is not the principal adverse effect demonstrated in the late-preterm corticosteroid trial.

E) Congenital hypothyroidism is not the relevant short-term neonatal adverse effect.

Stock SJ, Thomson AJ, Papworth S, on behalf of the Royal College of Obstetricians and Gynaecologists. Antenatal corticosteroids to reduce neonatal morbidity and mortality. BJOG. 2022;129:e35–e60. RCOG Green-top Guideline No. 74. doi:10.1111/1471-0528.17027.