{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T08:49:56Z","timestamp":1782895796443,"version":"3.54.5"},"reference-count":40,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"funder":[{"name":"2023 \u201cScience and Technology Rejuvenating Mongolia\u201d Shanghai Jiaotong University Action Plan special project","award":["2023XY JG0001-01-09"],"award-info":[{"award-number":["2023XY JG0001-01-09"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>\n                    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 (\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0=\u00a00.005). 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\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0&lt;\u00a00.05) 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\u20130.974]), bronchopulmonary dysplasia (BPD) (OR = 0.611, CI [0.377\u20130.989]), and the need for surgical intervention (OR = 0.609, CI [0.384\u20130.967]). After adjusting for multiple confounding factors, ACS still demonstrated a protective effect against NEC severity (OR = 0.401, CI [0.257\u20130.672]), while chorioamnionitis (OR = 3.586, CI [1.571\u20138.185]), invasive respiratory support prior to onset (OR = 3.045, CI [1.464\u20136.330]), prenatal antibiotic use (OR = 3.752, CI [1.700\u20138.277]), and partially hydrolyzed formula feeding (OR = 3.500, CI [1.372\u20138.945]) 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.\n                  <\/jats:p>","DOI":"10.7717\/peerj.21454","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T08:40:46Z","timestamp":1782895246000},"page":"e21454","source":"Crossref","is-referenced-by-count":0,"title":["Prenatal corticosteroid use improves the severity and complications of necrotizing enterocolitis in preterm infants: a retrospective multicenter clinical study in China"],"prefix":"10.7717","volume":"14","author":[{"given":"Chengyu","family":"Wang","sequence":"first","affiliation":[{"name":"Inner Mongolia Medical University, Hohhot, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Zhuo","sequence":"additional","affiliation":[{"name":"Inner Mongolia Medical University, Hohhot, China"},{"name":"Department of Neonatology, Inner Mongolia Maternity and Child Health Care Hospital, Hohhot, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanbin","family":"An","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Inner Mongolia Maternity and Child Health Care Hospital, Hohhot, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arigonggaowa","family":"Arigong","sequence":"additional","affiliation":[{"name":"Inner Mongolia Medical University, Hohhot, China"},{"name":"Department of Neonatology, Inner Mongolia Maternity and Child Health Care Hospital, Hohhot, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinglin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Quanzhou Maternity and Children\u2019s Hospital, Quanzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"He","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Jiangxi Provincial Children\u2019s Hospital, Nanchang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiexia","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bowen","family":"Weng","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiahuai","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Quanzhou Maternity and Children\u2019s Hospital, Quanzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cong","family":"Yu","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Jiangxi Provincial Children\u2019s Hospital, Nanchang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongmei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Quanzhou Maternity and Children\u2019s Hospital, Quanzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4443","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"10.7717\/peerj.21454\/ref-1","doi-asserted-by":"publisher","first-page":"1326765","DOI":"10.3389\/fped.2024.1326765","article-title":"Risk factors of necrotizing enterocolitis among neonates admitted to the neonatal intensive care unit at the selected public hospitals in southern Ethiopia, 2023","volume":"12","author":"Abebe","year":"2024","journal-title":"Frontiers in Pediatrics"},{"key":"10.7717\/peerj.21454\/ref-2","doi-asserted-by":"publisher","first-page":"37967","DOI":"10.1038\/srep37967","article-title":"Chorioamnionitis appears not to be a risk factor for patent ductus arteriosus in preterm infants: a systematic review and meta-analysis","volume":"6","author":"Behbodi","year":"2016","journal-title":"Scientific Reports"},{"key":"10.7717\/peerj.21454\/ref-3","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1001\/jama.2022.6812","article-title":"Neurodevelopment at 5 years of age according to early screening for patent ductus arteriosus in extremely preterm infants","volume":"328","author":"Cambonie","year":"2022","journal-title":"JAMA"},{"key":"10.7717\/peerj.21454\/ref-4","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.tjog.2019.01.017","article-title":"Maternal pregnancy-induced hypertension increases the subsequent risk of neonatal candidiasis: a nationwide population-based cohort study","volume":"58","author":"Chen","year":"2019","journal-title":"Taiwanese Journal of Obstetrics and Gynecology"},{"key":"10.7717\/peerj.21454\/ref-5","doi-asserted-by":"publisher","first-page":"e0306769","DOI":"10.1371\/journal.pone.0306769","article-title":"Patent ductus arteriosus (also non-hemodynamically significant) correlates with poor outcomes in very low birth weight infants. A multicenter cohort study","volume":"19","author":"Chesi","year":"2024","journal-title":"PLOS ONE"},{"key":"10.7717\/peerj.21454\/ref-6","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1515\/jpm-2022-0066","article-title":"The use of antenatal corticosteroids for fetal maturation: clinical practice guideline by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation","volume":"50","author":"Dagklis","year":"2022","journal-title":"Journal of Perinatal Medicine"},{"key":"10.7717\/peerj.21454\/ref-7","doi-asserted-by":"publisher","first-page":"104","DOI":"10.2174\/0115733963317134240801113609","article-title":"Clinical picture, diagnosis, management of NEC, and effects of probiotics on its prevention: a narrative review","volume":"21","author":"De Bernardo","year":"2025","journal-title":"Current Pediatric Reviews"},{"key":"10.7717\/peerj.21454\/ref-8","doi-asserted-by":"publisher","first-page":"770","DOI":"10.21037\/tp-24-15","article-title":"Advancing necrotizing enterocolitis prediction through iterative monitoring","volume":"13","author":"Dong","year":"2024","journal-title":"Translational Pediatrics"},{"key":"10.7717\/peerj.21454\/ref-9","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1016\/j.gtc.2024.11.001","article-title":"Dysbiotic microbiota in necrotizing enterocolitis: insights into pathogenesis, treatment, and prevention","volume":"54","author":"Frazer","year":"2025","journal-title":"Gastroenterology Clinics of North America"},{"key":"10.7717\/peerj.21454\/ref-10","doi-asserted-by":"publisher","first-page":"2253351","DOI":"10.1080\/14767058.2023.2253351","article-title":"The incidence and modifiable risk factors for necrotizing enterocolitis in preterm infants: a retrospective cohort study","volume":"36","author":"Gitau","year":"2023","journal-title":"The Journal of Maternal-Fetal & Neonatal Medicine"},{"key":"10.7717\/peerj.21454\/ref-11","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.jpeds.2020.11.067","article-title":"Population improvement bias observed in estimates of the impact of antenatal steroids to outcomes in preterm birth","volume":"232","author":"Gould","year":"2021","journal-title":"The Journal of Pediatrics"},{"key":"10.7717\/peerj.21454\/ref-12","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1515\/jpm-2022-0002","article-title":"Antenatal corticosteroids and neonatal outcomes in preterm birth in the United States","volume":"50","author":"Gulersen","year":"2022","journal-title":"Journal of Perinatal Medicine"},{"key":"10.7717\/peerj.21454\/ref-13","doi-asserted-by":"publisher","first-page":"B2","DOI":"10.1016\/j.ajog.2022.02.021","article-title":"Society for maternal-fetal medicine special statement: quality metrics for optimal timing of antenatal corticosteroid administration","volume":"226","author":"Hamm","year":"2022","journal-title":"American Journal of Obstetrics and Gynecology"},{"key":"10.7717\/peerj.21454\/ref-14","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1016\/j.chom.2025.09.014","article-title":"Gut bacteria metabolize natural and synthetic steroid hormones via the reductive OsrABC pathway","volume":"33","author":"Jacoby","year":"2025","journal-title":"Cell Host & Microbe"},{"key":"10.7717\/peerj.21454\/ref-15","doi-asserted-by":"publisher","first-page":"1535","DOI":"10.1080\/14767058.2019.1638906","article-title":"The relationship between histologic chorioamnionitis and decidual macrophage polarization and their influence on outcomes of neonates born before the 32nd gestational week","volume":"34","author":"Jasic","year":"2021","journal-title":"The Journal of Maternal-Fetal & Neonatal Medicine"},{"key":"10.7717\/peerj.21454\/ref-16","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1038\/s41390-024-03519-3","article-title":"Surgical necrotizing enterocolitis risk factors in extremely preterm infants: a Korean nationwide cohort study","volume":"97","author":"Kim","year":"2025","journal-title":"Pediatric Research"},{"key":"10.7717\/peerj.21454\/ref-17","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1016\/j.ejogrb.2020.08.003","article-title":"Antenatal corticosteroids administration on mortality and morbidity in premature twins born at 25\u223c34 gestational weeks: a retrospective multicenter study","volume":"253","author":"Kong","year":"2020","journal-title":"European Journal of Obstetrics and Gynecology and Reproductive Biology"},{"key":"10.7717\/peerj.21454\/ref-18","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1146\/annurev-pathmechdis-070224-014223","article-title":"Exploring the complex pathophysiology of necrotizing enterocolitis in preterm neonates","volume":"21","author":"Li","year":"2026","journal-title":"Annual Review of Pathology"},{"key":"10.7717\/peerj.21454\/ref-19","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1186\/s13052-025-01930-y","article-title":"Analysis of risk factors and establishment of predictive models for neonatal necrotizing enterocolitis: a retrospective study","volume":"51","author":"Liu","year":"2025","journal-title":"Italian Journal of Pediatrics"},{"key":"10.7717\/peerj.21454\/ref-20","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s12887-021-02973-w","article-title":"Predictive factors for the surgical treatment of necrotizing enterocolitis in preterm infants: a single-center retrospective study","volume":"22","author":"Liu","year":"2022","journal-title":"BMC Pediatrics"},{"key":"10.7717\/peerj.21454\/ref-21","doi-asserted-by":"publisher","first-page":"908","DOI":"10.7499\/j.issn.1008-8830.2202085","article-title":"Risk factors for necrotizing enterocolitis in preterm infants: a meta analysis","volume":"24","author":"Lu","year":"2022","journal-title":"Zhongguo Dang Dai Er Ke Za Zhi"},{"key":"10.7717\/peerj.21454\/ref-22","doi-asserted-by":"publisher","first-page":"CD004454","DOI":"10.1002\/14651858.CD004454.pub4","article-title":"Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth","volume":"12","author":"McGoldrick","year":"2020","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"10.7717\/peerj.21454\/ref-23","doi-asserted-by":"publisher","first-page":"e076035","DOI":"10.1136\/bmj-2023-076035","article-title":"The proportions of term or late preterm births after exposure to early antenatal corticosteroids, and outcomes: systematic review and meta-analysis of 1.6 million infants","volume":"382","author":"Ninan","year":"2023","journal-title":"BMJ"},{"key":"10.7717\/peerj.21454\/ref-24","doi-asserted-by":"publisher","first-page":"e220483","DOI":"10.1001\/jamapediatrics.2022.0483","article-title":"Evaluation of long-term outcomes associated with preterm exposure to antenatal corticosteroids: a systematic review and meta-analysis","volume":"176","author":"Ninan","year":"2022","journal-title":"JAMA Pediatrics"},{"key":"10.7717\/peerj.21454\/ref-25","doi-asserted-by":"publisher","first-page":"516","DOI":"10.3389\/fped.2020.00516","article-title":"Molecular and mechanical mechanisms regulating ductus arteriosus closure in preterm infants","volume":"8","author":"Oval\u0131","year":"2020","journal-title":"Frontiers in Pediatrics"},{"key":"10.7717\/peerj.21454\/ref-26","doi-asserted-by":"publisher","first-page":"1982","DOI":"10.1016\/j.jpedsurg.2023.06.009","article-title":"Antimicrobial stewardship in neonates with necrotizing enterocolitis: a quality improvement initiative","volume":"58","author":"Pace","year":"2023","journal-title":"Journal of Pediatric Surgery"},{"key":"10.7717\/peerj.21454\/ref-27","doi-asserted-by":"publisher","first-page":"151591","DOI":"10.1016\/j.semperi.2022.151591","article-title":"Periventricular\u2014intraventricular hemorrhage in the premature infant\u2014a historical perspective","volume":"46","author":"Perlman","year":"2022","journal-title":"Seminars in Perinatology"},{"key":"10.7717\/peerj.21454\/ref-28","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1186\/s13613-024-01336-9","article-title":"Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment\u2014a comprehensive review","volume":"14","author":"Pfortmueller","year":"2024","journal-title":"Annals of Intensive Care"},{"key":"10.7717\/peerj.21454\/ref-29","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1515\/jpm-2024-0024","article-title":"Antenatal corticosteroids for late small-for-gestational-age fetuses","volume":"53","author":"Sgayer","year":"2025","journal-title":"Journal of Perinatal Medicine"},{"key":"10.7717\/peerj.21454\/ref-30","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1097\/aog.0000000000004835","article-title":"Antenatal corticosteroids and neonatal outcomes in twins: a systematic review and meta-analysis","volume":"140","author":"Socha","year":"2022","journal-title":"Obstetrics & Gynecology"},{"key":"10.7717\/peerj.21454\/ref-31","doi-asserted-by":"publisher","first-page":"106056","DOI":"10.1016\/j.phrs.2022.106056","article-title":"Modulation of intestinal barrier function by glucocorticoids: Lessons from preclinical models","volume":"177","author":"Tena-Garitaonaindia","year":"2022","journal-title":"Pharmacological Research"},{"key":"10.7717\/peerj.21454\/ref-32","doi-asserted-by":"publisher","first-page":"S257","DOI":"10.1093\/infdis\/jiaa604","article-title":"Necrotizing enterocolitis and the microbiome: current status and future directions","volume":"223","author":"Th\u00e4nert","year":"2021","journal-title":"The Journal of Infectious Diseases"},{"key":"10.7717\/peerj.21454\/ref-33","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1007\/s13224-022-01664-5","article-title":"Elucidating the effect of antenatal corticosteroids in the late preterm period","volume":"73","author":"Upadhya","year":"2023","journal-title":"The Journal of Obstetrics and Gynecology of India"},{"key":"10.7717\/peerj.21454\/ref-34","doi-asserted-by":"publisher","first-page":"e2345299","DOI":"10.1001\/jamanetworkopen.2023.45299","article-title":"Patent ductus arteriosus and bronchopulmonary dysplasia-associated pulmonary hypertension: a Bayesian meta-analysis","volume":"6","author":"Villamor","year":"2023","journal-title":"JAMA Network Open"},{"issue":"4","key":"10.7717\/peerj.21454\/ref-35","doi-asserted-by":"publisher","first-page":"1196","DOI":"10.1038\/s41390-025-04237-0","article-title":"Prenatal corticosteroid use improves the severity and complications of necrotizing enterocolitis in preterm infants: a multicenter clinical study in China","volume":"98","author":"Wang","year":"2025","journal-title":"Pediatric Research"},{"key":"10.7717\/peerj.21454\/ref-36","doi-asserted-by":"publisher","first-page":"CD006764","DOI":"10.1002\/14651858.CD006764.pub4","article-title":"Different corticosteroids and regimens for accelerating fetal lung maturation for babies at risk of preterm birth","volume":"8","author":"Williams","year":"2022","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"10.7717\/peerj.21454\/ref-37","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1159\/000504371","article-title":"An overview of systematic reviews of randomized-controlled trials for preventing necrotizing enterocolitis in preterm infants","volume":"117","author":"Xiong","year":"2020","journal-title":"Neonatology"},{"key":"10.7717\/peerj.21454\/ref-38","doi-asserted-by":"publisher","DOI":"10.1016\/j.pedneo.2021.08.020","article-title":"Dose completion of antenatal corticosteroids and neonatal outcomes in non-small-for-gestational age or small-for-gestational age very-low-birthweight infants: a Korean population-based cohort study","author":"Yum","year":"2021","journal-title":"Pediatrics and Neonatology"},{"key":"10.7717\/peerj.21454\/ref-39","doi-asserted-by":"publisher","first-page":"5437","DOI":"10.1038\/s41467-023-41147-3","article-title":"Exosomal circEZH2_005, an intestinal injury biomarker, alleviates intestinal ischemia\/reperfusion injury by mediating Gprc5a signaling","volume":"14","author":"Zhang","year":"2023","journal-title":"Nature Communications"},{"key":"10.7717\/peerj.21454\/ref-40","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.etap.2017.02.021","article-title":"Recent advances in the study of 11\u03b2-hydroxysteroid dehydrogenase type 2 (11\u03b2-HSD2) inhibitors","volume":"52","author":"Zhou","year":"2017","journal-title":"Environmental Toxicology and Pharmacology"}],"container-title":["PeerJ"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/peerj.com\/articles\/21454.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/21454.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/21454.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/21454.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T08:40:49Z","timestamp":1782895249000},"score":1,"resource":{"primary":{"URL":"https:\/\/peerj.com\/articles\/21454"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":40,"alternative-id":["10.7717\/peerj.21454"],"URL":"https:\/\/doi.org\/10.7717\/peerj.21454","archive":["CLOCKSS","LOCKSS","Portico"],"relation":{},"ISSN":["2167-8359"],"issn-type":[{"value":"2167-8359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"article-number":"e21454"}}