Nigeria: Antenatal Corticosteroids Study

The administration of antenatal corticosteroids (ACS) has long been considered a cornerstone in preterm labor management, aimed at improving neonatal outcomes, particularly respiratory health. However, a recent study published in BMC Pregnancy and Childbirth delves into the efficacy of ACS, specifically in babies born during the late preterm period, shedding light on its impact on respiratory morbidity.

The study found that dexamethasone administration to women at risk for late preterm delivery significantly reduces the rate of neonatal intensive care unit admission, neonatal respiratory complications, and the need for active resuscitation at birth. Most studies have used dexamethasone or betamethasone as the antenatal steroid. Current research has not shown any significant differences in complication or efficacy of both drugs, hence the choice of dexamethasone in this study. Also, the study was done in a low-resource setting where dexamethasone is significantly cheaper than betamethasone. Considering this, Khadijah A. Shittu, Department of Obstetrics & Gynaecology, Lagos State University Teaching Hospital, Lagos, Nigeria, and colleagues aimed to determine whether antenatal corticosteroids use reduces respiratory morbidity in late preterm babies in the Nigerian population.

For this purpose, the researchers studied two hundred and eighty-six pregnant women at risk of having a late preterm delivery. One hundred and forty-three served as the cases and were given 2 doses of 12 mg intramuscular dexamethasone 12 hours apart. In contrast, 143 served as the controls and were given a similar quantity of placebo. Women were prospectively followed up, and data were collected on the pregnant women and their newborns on a standardized form. The neonates were evaluated for acute respiratory distress syndrome and transient tachypnea of the newborn based on clinical signs, chest x-ray results (when indicated), and symptoms. The primary outcome was the occurrence of neonatal respiratory morbidity.

Study Findings

• The primary outcome occurred in 3.8% of infants in the dexamethasone group and 25.4% of infants in the placebo group.
• Birth asphyxia, neonatal intensive care admission, and need for active resuscitation at birth also occurred significantly less frequently in the dexamethasone group.
• There were no significant group differences in the incidence of neonatal sepsis, hypoglycemia, neonatal jaundice, and feeding difficulties.

As the medical community continues to grapple with the complexities of preterm birth management, studies like this serve as vital guides, informing clinical practice and guiding the delivery of care to optimize outcomes for newborns born during the late preterm period.

Reference

Shittu, K.A., Ahmed, B., Rabiu, K.A. et al. Does the use of antenatal corticosteroids reduce respiratory morbidity in babies born in late preterm period?. BMC Pregnancy Childbirth 24, 334 (2024). https://doi.org/10.1186/s12884-024-06304-6