Respiratory distress (RD) is higher among newborns born by caesarean section (CS) at term. RCOG recommend steroid administration for CS prior to 39 weeks. Evidence for effectiveness of steroids for neonatal RD at term is inconclusive. The racial differences are yet to be studied. 

A single center retrospective cohort study was conducted in Colombo, Sri Lanka form December 2016 to February 2019. All mothers delivered by CS between 37+0 and 38+6 weeks were included in the study. Mothers with severe maternal hypertension, severe fetal rhesus sensitization, evidence of intrauterine infection, multiple pregnancies and those who received steroids due to other indications at a prior gestation and were excluded. Cohort was subdivided according to administration of IM dexamethasone prior to CS. Primary outcomes measured were RD, admissions to neonatal intensive care unit (NICU) and special care baby unit (SCBU). Neonatal infections and maternal duration of hospital stay was recorded as secondary outcome measures. 

560 patients were included in the study. 23.2% of patients received antenatal corticosteroids. Incidence of RD, NICU admissions and SCBU admissions in the study cohort was 10%, 0.9%, 2.7% respectively. RR for developing RD in the steroid group compared to non-steroid group was 2.67 (1.64-4.35). NICU and SCBU admissions was needed by 4.6% in steroid group and 3.3% in non-steroid group without a significant difference (p=0.464). A significantly higher number of babies in the steroid group needed IV antibiotics. Average days the mothers were admitted in the hospital was 2.45 days (SD 1.424) for steroid group and 1.4 days (SD 0.856) for the non-steroid group (p < 0.001).

There is a significant increase in the respiratory morbidity in the dexamethasone administered south Asian mothers at term prior to CS. However, this effect has no clinical significance since the admission to NICU and SCBU were not significantly different.