Antenatal steroids improve preterm infant endurance in low-asset settings, discovers study

Overview

• Post By : Kumar Jeetendra


• Source: The World Health Organization


• Date: 24 Oct,2020

The results of a new clinical trial, published today in the New England Journal of Medicine, show that dexamethasone- a glucocorticoid used to treat many conditions, including rheumatic problems and severe COVID-19- may boost survival of premature babies when given to pregnant women at risk of premature birth in low-resource settings.

The WHO ACTION-I trial resolves a continuing controversy about the effectiveness of antenatal steroids for improving preterm newborn survival in low-income countries. Dexamethasone and similar drugs have long shown to be effective in saving preterm babies lives in high-income nations, where high-quality newborn care is more accessible. This is the first time a clinical trial has proven that the drugs are also effective in low-income settings.

Dexamethasone is now a proven drug to save babies born too soon in low-income settings. But it is only effective when administered by health-care providers who can make timely and accurate decisions, and provide a minimum package of high-quality care for both pregnant women and their babies.”Dr. Olufemi Oladapo, head of maternal and perinatal health unit at WHO and HRP, and one of the coordinators of the study

The effect is significant: for every 25 pregnant women treated with dexamethasone, one premature baby’s life was saved. When administered to mothers at risk of preterm birth, dexamethasone crosses the placenta and accelerates lung growth, making it less possible for preterm infants to have respiratory problems at birth.

Globally, prematurity is the leading cause of death in children under the age of 5. Every year, an estimated 15 million babies are born too early, and 1 million die due to complications caused by their early birth. In low-income settings, half of the babies born at or below 32 weeks die due to a lack of viable, cost-effective care.

The research notes, healthcare providers should have the capacity to pick the girls most likely to benefit from the medication and to properly initiate the treatment at the right time — ideally 48 hours prior to giving birth to give enough time to complete steroid injections for maximal effect. Women that are in weeks 26-34 of the pregnancy are most likely to benefit from the steroid, so health care providers must also have access to ultrasound to accurately date their pregnancies. Additionally, babies must receive sufficiently good-quality care when they’re born.

“When a minimal package of care for newborn babies — such as management of infection, feeding support, thermal care and access to a CPAP machine to support respiration — is set up in low-income nations, antenatal steroids such as dexamethasone can help save preterm babies’ lives,” says Dr Rajiv Bahl, head of the newborn health unit in WHO and one of the study coordinators.

Conducted from December 2017–November 2019, the randomized trial recruited 2852 women and their 3070 babies from 29 secondary and tertiary level hospitals in Bangladesh, India, Kenya, Nigeria, and Pakistan.