Background: Respiratory distress syndrome (RDS) remains the most important determinant of increasing neonatal morbidity in preterm infants. A low secretory capacity of the adrenal cortex may cause a diminished stress response during the acute illness in preterm infants and could lead to increased morbidity in these infants.
Objective: To evaluate the levels of antenatal steroid (cortisol) in the 1^st and 3^rd days of life in preterm neonates with respiratory distress syndrome.
Patients and methods: This study was carried out in neonatal intensive care unit (NICU) of Benha University Hospital from June, 2020 to January, 2022. The study included 45 preterm neonates (23 females and 22 males), with gestational age ranged from 30 to 36 weeks, and their weights ranged between 1.100 kg to 2.700 kg (all of them were appropriate for gestational age (AGA) with mean weight 1.800 + 0.300 kg).
Results: In the current study, in ROC curve and area under the curve shows that 3^rd day serum cortisol significantly could be used as a predictive measure in cases prognosis with probability of 71% that the assay result for a randomly chosen positive case will exceed the result for a randomly chosen negative case. Among respiratory distress groups (2 and 3) 3^rd day serum cortisol level of 485.5 (nmol/l) was chosen as a cutoff point below which cases with respiratory distress tend to show improvement in prognosis with sensitivity of 80% and specificity of 80%.
Conclusion: Preterm infants with severe RDS (mechanically ventilated) release more cortisol, which could be the result of severe stress associated with respiratory distress and positive pressure ventilation. Increased incidence and severity of RDS were noticed more in cesarean section (CS) than in vaginal delivery (VD). Antenatal steroids have effective role in decreasing incidence and severity of RDS.