Receipt of antenatal steroids and respiratory support among premature infants exposed to prenatal smoking and substance use

Abstract

Objectives: The current study examined the likelihood of receipt of newborns' respiratory support among preterm infants whose mothers reported cigarette smoking and/or illicit drug use while they were pregnant.
Methods: Secondary data analyses of an existing database at a single institution were conducted between 1997 and 2015 for infants of gestational age between 24 and 34 weeks.
Results: Among 7,505 infants, 17% were exposed to prenatal cigarette smoking, 8% to any illicit drug, and 5% to more than one substance. Adjusted analyses showed exposure to cigarette smoking was associated with lower likelihood of receiving respiratory support (any support: AOR: 0.75, 95% CI: 0.60 to 0.94; supplemental oxygen: AOR: 0.77, 95% CI: 0.62 to 0.97), and exposure to cocaine was associated with lower likelihood of receiving antenatal corticosteroids (AOR: 0.54; 95% CI: 0.34 to 0.85) and more use of mechanical ventilation (AOR: 1.85; 95% CI: 1.08 to 3.17).
Conclusion: Despite fewer respiratory issues among nicotine-exposed infants, identification of polysubstance use and counseling smoking parents on secondhand smoke exposure after hospital discharge should be emphasized in care. Identifying mothers using illicit substances, especially cocaine, and encouraging them to come into triage early in threatened preterm labor may increase antenatal corticosteroid treatment exposure and avoid an intense respiratory support in infants.