A decade of Experience with use of Antenatal Corticosteroids in Preterm Birth: Maternal and Neonatal Outcomes in the Resource-Constraints Setting of Maiduguri, North-Eastern Nigeria
Keywords:
Antenatal corticosteriods, dexamethasone, PPROM, RDS, survivalAbstract
Background:
According to the American College of Obstetrics and Gynaecology (ACOG) and American Academy of Pediatrics (AAP), administration of antenatal corticosteroids to mothers presented in imminent preterm birth is strongly associated with decreased neonatal morbidity and mortality. It enhances lung maturity and surfactant in the alveolar sacs from 22 to 28 weeks gestation.
Objective:
To review the beneficial effect ACS (dexamethasone) among pregnant mothers with imminent preterm birth at labour ward and admitted at special care baby unit of University of Maiduguri Teaching Hospital over ten-year duration (2012 to 2022).
Subject and method:
This is a retrospective study of 425 of women who had preterm birth with complete information were retrieved and analyzed after obtaining ethical clearance from the hospital’s ethics and research committee.
Result:
During the 10 years study period, 21,458 births and of these, 425 deliveries were below 37 completed weeks, and all benefitted from treatment with antenatal corticosteroids. The preterm birth had at least 2 doses of dexamethasone at dose of 6 mg 12 hourly apart, with prevalence of (2.3%). before birth. There was improved APGAR score (≥7 at 1 and 5 minutes) and respiratory distress syndrome, necrotizing enterocolitis were equally low among the babies in whom mothers had at least 2 doses of ACS.
Conclusion:
Antenatal corticosteroid administration in preterm birth (2.3%) was very low. Dexamethasone use in preterm birth had proven beneficial in improving survival among preterm babies. We are suggesting further research in the use of antenatal/prenatal dexamethasone in imminent preterm birth.
References
REFERENCES
ACOG, Committee on Obstetric Practice. ACOG Committee Opinion No. 713: Antenatal corticosteroid therapy for foetal lung maturation. Obstet Gynaecol 2017; 130 (2): e102-109.
Peri-viable birth. Obstetric Care Consensus No. 4. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;127:e157–69.
Premature rupture of membranes. Practice Bulletin No. 172. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;128:e165–77
Management of preterm labor. Practice Bulletin No. 171. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;128:e155–6
Collaborators WHO ACTION TRIALS. Effect of dexamethasone on newborn survival at different administration-to-birth intervals: a secondary analysis of the WHO ACTION (Antenatal CorticosTeroids for Improving Outcomes in Preterm Newborn)-I trial. e Clinical Medicine. 2022;53:1017-44.
De Costa A, Moller A-B, Blencowe H, Johansson EW, Hussain-Alkhateeb L, Ohuma EO, et al. (2021) Study protocol for WHO and UNICEF estimates of global, regional, and national preterm birth rates for 2010 to 2019. PLoS ONE 16(10): e0258751. https://doi.org/10.1371/journal.pone.0258751
Ohuma EO, Moller AB, Bradley E, Chakwera S, Hussein-Alkhateeb L, Lewin A et al. National, Reginal and global estimates of preterm births in 2020 with trends from 2010; a systematic analysis. Lancet 2023;402:1261-1271.
Platt MJ. Outcomes in preterm infants. Public Health. 2014;128(5):399–403
Islam JY, Keller RL, Aschner JL, Hartert TV, Moore PE. Understanding the short- and long-term respiratory outcomes of prematurity and bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2015;192(2):134–56.
Schnabl KL, Van Aerde JE, Thomson AB, Clandinin MT. Necrotizing enterocolitis: a multifactorial disease with no cure. World J Gastroenterol. 2008;14(14):2142–61.
Blondel B, Truffert P, Lamarche-Vadel A, Dehan M, Larroque B. Use of medical services by very preterm children during the first year of life in the Epipage cohort. Arch Pediatr. 2003;10(11):960–8
Srinivasjois R, Slimings C, Einarsdóttir K, Burgner D, Leonard H. Association of gestational age at birth with reasons for subsequent hospitalisation: 18 WHO ACTION Trials Collaborators Trials (2019) 20:507 Page 10 of 11 years of follow-up in a Western Australian population study. PLoS One. 2015;10(6):e0130535.
Kemp MW, Newnham JP, Challis JG, Jobe AH, Stock SJ. The clinical use of corticosteroids in pregnancy. Hum Reprod Update. 2015
Ballard PL, Ballard RA. Scientific basis and therapeutic regimens for use of antenatal glucocorticoids. Am J Obstet Gynecol. 1995;173(1):254 –62
Anderson PJ, Doyle LW, Group VICS. Executive functioning in school-aged children who were born very preterm or with extremely low birth weight in the 1990s. Pediatrics. 2004;114(1):50 –7
Korvenranta E, Lehtonen L, Rautava L, Häkkinen U, Andersson S, Gissler M, Hallman M, Leipälä J, Peltola M, Tammela O, et al. Impact of very preterm birth on health care costs at five years of age. Pediatrics. 2010;125(5):e1109 –14
Roberts D, Brown J, Medley N and Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database of Syst Rev 2017;(3)CD004454 doi:1002/14651858.Cd004454.pub3
WHO Recommendations on interventions to improve preterm birth outcomes. Geneva: World Health Organization; 2015
Vogel JP, Oladapo OT, Pileggi-Castro C, Adejuyigbe EA, Althabe F, Ariff S, et al. Antenatal corticosteroids for women at risk of imminent preterm birth in low-resource countries: the case for equipoise and the need for efficacy trials. 2017; BMJ Global Health, 2(3), 1-7.
Norman, J.; Shennan, A.; Jacobsson, B.; Stock, S.J.; FIGO Working Group for Preterm Birth. FIGO good practice recommendations on the use of prenatal corticosteroids to improve outcomes and minimize harm in babies born preterm. Int. J. Gynaecol. Obstet. 2021, 155, 26–30.
Report of the WHO Expert Committee on Selection and Use of Essential Medicines, 2017 (including the 20th WHO Model List of Essential Medicines and the 6th WHO Model List of Essential Medicines for Children). Geneva: World Health Organization; 2017.
World Health Organization (WHO). WHO Recommendations on Interventions to Improve Preterm Birth Outcomes. Geneva:WHO;2015.http://www.who.int/reproductivehealth/ publications/maternal_perinatal_health/preterm-birth-guideline/en/. Accessed
October 19, 2018.
Greensides D, Robb-McCord J, Nuriega A and Litch JA. Antenatal corticosteroids for women at risk of imminent preterm birth in 7 sub-Saharan African Countries: A policy and implementation landscape analysis. Global Health: Science and Practice; 2018,4(6);644-656
Mwita S, Konje E, Kamala B, Izina A, Kilonzo S, Kigombola A, et al. (2021) Association between antenatal corticosteroid use and perinatal mortality among preterm births in hospitals in Tanzania. PLoS ONE 16(7): e0254916. https://doi.org/10.1371/journal.pone.0254916
Sackey AH and Tagoe LG. Audit of Antenatal Corticosteroid use in mothers of preterms admitted to a neonatal intensive care unit in Ghana. Ghana Med J.2018; 52(1):3-7
Liu G, Segre J, Gulmezoglu AM, Mathai M, Smith JM, Hermeda J et al : Antenatal corticosteroids for management of preterm birth: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy and Childbirth 2015 15(Suppl 2):S3
Committee Opinion No. 677. ACOG committee opinion: antenatal corticosteroids therapy for fetal maturation. Obstet Gynecol 2016;128:e187-94.doi:10.1097/AOG. 0000000000001715.
Royal College of Obstetricians and Gynaecologists (RCOG). Antenatal corticosteroids to prevent respiratory distress syndrome. Clinical Green Top Guidelines. Royal College of Obstetricians and Gynaecologists, 2004
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