Comparison of respiratory distress syndrome amongst preterm twins (28-34 Weeks) born within and after two weeks of completion of single antenatal corticosteroid course: A bidirectional cohort study

Baseline maternal characteristics		<14 Days Group A	>14 Days Group B
Baseline maternal characteristics		(N=134)	(N=134)
AGE years	19-25 years	62(46.27%)	47(35.07%)	0.017^a
	26-34 years	66(49.25%)	69(51.49%)	(𝑥² = 8.13)
	≥35 years	6(4.48%)	18(13.43%)	(𝑥² = 8.13)
EDUCATION	Illiterate	2(1.4%)	1(0.7%)	0.531 (𝑥² =7.05)
	Primary	16(11.9%)	15(11.5%)
	Middle	53(39.5%)	50(37.3%)
	Higher	49 (36.5%)	49(36.6%)
	Graduation	14 (10.4%)	19(14.2%)
PARITY	Primigravida	101(75.67%)	98 (73.13%)	0.675 (𝑥² =0.17)
PARITY	Multigravida	33 (24.33%)	36 (26.87%)	0.675 (𝑥² =0.17)
TYPE OF STEROID	Betamethasone	246	196	<0.0001 ^a (𝑥² = 32.25)
TYPE OF STEROID	Dexamethasone	22	72	<0.0001 ^a (𝑥² = 32.25)
MODE OF CONCEPTION	SPONTANEOUS (n=141)	83(61.94%)	58(43.28%)	0.002* (𝑥² = 17.25)
MODE OF CONCEPTION	ASSISTED (n=127)	51 (40.2%)	76 (59.8%)	0.002* (𝑥² = 17.25)
CHORIONICITY	Monochorionic (n=58)	26(19.40%)	32(23.88%)	0.373 (𝑥² =0.79)
CHORIONICITY	Dichorionic (n=210)	108(80.60%)	102(76.12%)
COMORBIDITY	HTD^b (n=58)	26(19.40%)	32(23.88%)	0.013 ^a 𝑥² =(8.88)
Preterm premature rupture of membranes		63(23.5%)	17(6.3%)	<0.00001 ^a (𝑥² = 31.5)
GESTATIONAL AGE at DELIVERY	Mean ± SD^c	31.5(±2.09)	32.6 (± 1.75)	<0.001 ^a
	28-29⁺⁶(n=52)	38(28.36%)	14(10.45%)	<.001 ^a (𝑥² =40.716)
	30-32⁺⁶(n=68)	39(29.10%)	29(21.64%)
	33-34 (n=148)	57(42.54%)	91(67.91%)
MODE OF DELIVERY	Caesarean (n=232)	95(35.4%)	137(51.1%)	<0.001 ^a (𝑥² =13.40)
MODE OF DELIVERY	Vaginal (n=304)	173(64.6%)	131(48.9%)	<0.001 ^a (𝑥² =13.40)

[i] a- significant. b- Hypertensive disorders. c-SD= standard deviation.

Table 2

Multivariable regression analysis of factors influencing respiratory distress syndrome and neonatal deaths

Variable (Reference Group)		RDS (respiratory distress syndrome)		Neonatal Deaths
Variable (Reference Group)		ARR^a (95% CI^b)	P-value	ARR^a (95% CI^b)	P-value
Steroid Group B (Ref-GroupA)		1.09 (0.84-1.4)	0.510	1.06 (0.620-1.8)	0.810
Twin Order 2 (Ref-Twin order1)		1.012 (0.790-1.2)	0.921	1.20 (0.72-2.00)	0.484
Twin Dichorionic (Ref-monochrionic)		1.01 (0.744-1.3)	0.920	1.11 (0.53- 2.30)	0.778
Period of Gestation(weeks) (Ref-33-33⁺⁶weeks)	28-29⁺⁶	1.84 (1.17-2.8)	0.008^c	1.75 (0.48-6.3)	0.392
Period of Gestation(weeks) (Ref-33-33⁺⁶weeks)	30-32⁺⁶	1.75 (1.1-2.5)	0.004^c	1.49 (0.405-5.52)	0.545
Caesarean Delivery (Ref-Vaginal Delivery) -		1.28 (0.95-1.7)	0.102	0.987 (0.454-2.14)	0.975
Birth Weight (Ref- ≥ 2kg)	<1 kg	5.60 (2.7-11.2)	0.0011 ^c	26.06 (2.37-285.5)	0.008 ^c
	1-1.49 kg	5.23 (2.8-9.6)	0.0001 ^c	6.30 (0.619-64.09)	0.120
	1.5-1.99 kg	2.8 (1.5-5)	0.001 ^c	0.716 (0.434-11.82)	0.816
1 min Apgar< (Ref- I min Apgar score>7)				2.46 (0.81-7.41)	0.110
Sex Male (Ref- Female)				1.07 (0.62-1.82)	0.802

[i] a- ARR= adjusted relative risk, b-CI=confidence interval. c- significant

Table 3

Propensity-matched scoring

Outcome	Grouping	Matched Pairs	Adjusted Relative Risk (95% CI^a)	P-value
RDS^b	<14 vs >14 days	Grp A (n=180)	ref
		Grp B (n=180)	1.13 (0.93-1.33)	0.231
ND^c	<14 vs >14 days	Grp A (n=180)	ref
		Grp B (n=180)	2.0 (1.03-3.88)	0.017
RDS	<7 vs >7 days	Grp A (n=161)	ref
		Grp B (n=161)	1.04 (0.84-1.28)	0.722
ND	<7 vs >7 days	Grp A (n=161)	ref
		Grp B (n=161)	1.85 (0.97-3.50)	0.052

[i] a- CI: confidence interval. b-RDS: respiratory Distress Syndrome. c- ND: Neonatal death.

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DOI: https://doi.org/10.34763/jmotherandchild.20212504.d-21-00034 | Journal eISSN: 2719-535X | Journal ISSN: 2719-6488

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Language: English

Page range: 260 - 268

Submitted on: Nov 26, 2021

Accepted on: Jan 20, 2022

Published on: Apr 18, 2022

Published by: Institute of Mother and Child

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

Antenatal corticosteroids,

Preterm twins,

Perinatal morbidity,

Respiratory distress syndrome,

Respiratory morbidity,

Steroid-delivery interval

Related subjects:

Medicine,

Clinical medicine,

Pediatrics and juvenile medicine,

Paediatric haematology and oncology,

Public health

© 2022 Monisha J Arulalan, Gowri Dorairajan, Nivedita Mondal, Palanivel Chinnakali, published by Institute of Mother and Child
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 25 (2021): Issue 4 (December 2021)

Comparison of respiratory distress syndrome amongst preterm twins (28-34 Weeks) born within and after two weeks of completion of single antenatal corticosteroid course: A bidirectional cohort study

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