Prenatal corticosteroid use improves the severity and complications of necrotizing enterocolitis in preterm infants: a retrospective multicenter clinical study in China

Our study is a retrospective multicenter observational cohort study to investigate effect of the use of antenatal corticosteroids (ACS) in preterm infants on the severity of necrotizing enterocolitis (NEC) and its associated complications. We collected clinical data from 443 preterm infants with gestational age (GA) of less than 37 weeks who were diagnosed with NEC in four hospitals across various provinces in China, covering the period from June 2020 to June 2024. According to whether they received a full course of prenatal corticosteroid treatment in the week before delivery, infants were divided into the exposed group and the unexposed group. A total of 213 preterm infants (48.08%) had received ACS therapy. When compared to the non-exposed group, the severity of NEC in the exposed group demonstrated a statistically significant difference ( p  = 0.005). Comparative analysis revealed that ethnicity, chorioamnionitis, antenatal steroid use, antenatal antibiotic use, premature rupture of membranes, gestational age, age at onset, respiratory support mode at onset, presence of intracranial hemorrhage before onset, postnatal occurrence of hemodynamically significant patent ductus arteriosus (hsPDA), absolute white blood cell count at onset, absolute platelet count at onset, and serum creatinine (SCr) levels during NEC (all p  < 0.05) were identified as risk factors influencing NEC severity. In the univariate regression analysis, ACS therapy was identified as a significant protective factor against the occurrence of hsPDA (OR = 0.612, CI [0.385–0.974]), bronchopulmonary dysplasia (BPD) (OR = 0.611, CI [0.377–0.989]), and the need for surgical intervention (OR = 0.609, CI [0.384–0.967]). After adjusting for multiple confounding factors, ACS still demonstrated a protective effect against NEC severity (OR = 0.401, CI [0.257–0.672]), while chorioamnionitis (OR = 3.586, CI [1.571–8.185]), invasive respiratory support prior to onset (OR = 3.045, CI [1.464–6.330]), prenatal antibiotic use (OR = 3.752, CI [1.700–8.277]), and partially hydrolyzed formula feeding (OR = 3.500, CI [1.372–8.945]) were identified as significant risk factors for NEC severity. Therefore, ACS can reduce the severity of NEC and lower the incidence of hsPDA, BPD, and the necessity for surgical in preterm infants.