Accurate pregnancy dating and quality care combined with the steroids are key to survival
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— can boost survival of
premature babies when given to pregnant women at risk of preterm birth in low-resource
settings.
The WHO ACTION-I trial resolves an ongoing controversy about the efficacy 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 countries, 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.
The impact 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 development, making it less likely for preterm babies to have
respiratory problems at birth.
“Dexamethasone is now a proven drug to save babies born too soon in low-income
settings,” says Dr Olufemi Oladapo, head of
maternal and perinatal health unit at WHO and HRP, and one of the coordinators
of the study. “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.”
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 resulting from their early birth. In low-income settings, half
of the babies born at or below 32 weeks die due to a lack of feasible, cost-effective
care.
The study notes, healthcare providers must have the means to select the women
most likely to benefit from the drug and to correctly initiate the treatment at
the right time – ideally 48 hours before giving birth to give enough time to
complete steroid injections for maximal effect. Women who are in weeks 26-34 of
their pregnancy are most likely to benefit from the steroid, so healthcare
providers must also have access to ultrasound to accurately date their
pregnancies. In addition, babies must receive sufficiently good-quality care
when they are born.
“When a minimal package of care for newborn babies – including management of
infection, feeding support, thermal care and access to a CPAP machine to
support respiration – is in place in low-income countries, antenatal steroids
such as dexamethasone can help to save preterm babies’ lives,” says Dr Rajiv
Bahl, head of the newborn health unit at 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. Beyond finding a significantly
lower risk of neonatal death and stillbirth, the study also found there was no increase
in possible maternal bacterial infections when treating pregnant women with
dexamethasone in low-resource settings.
Source: World Health Organization
No comments:
Post a Comment