KARACHI: A new World Health Organisation (WHO) study reveals that only half of women who gave birth pre-term in hospitals have received steroid injections which prevent death and disability among vulnerable, pre-term newborns. The study is the largest to look at the use of these life-saving drugs internationally. These drugs have existed for decades, don’t require refrigeration, and cost less than $1 per injection.
Pre-term babies lungs are often not fully developed and they can have breathing problems soon after birth, which can be fatal. An injection of corticosteroids – given to a mother in pre-term labour or at risk for pre-term birth – triggers production of surfactant (a protein substance produced by lung cells to facilitate breathing) in the baby’s lungs. It is known to be the most effective intervention to reduce the risk of respiratory distress syndrome among pre-term babies born in hospitals where access to further newborn care is available. This is the standard-of-care for women in pre-term labour between 26 and 34 weeks gestation (a full-term pregnancy is 40 weeks).
The study, conducted across 29 countries, mostly low- and middle-income, is published in The Lancet medical journal. It used data from the WHO Multi-country Survey on Maternal and Newborn Health to examine the use of antenatal corticosteroids and tocolytic drugs (which slow down labour, giving more time for antenatal corticosteroids to work) across more than 300 000 births in 359 hospitals between May 2010 and December 2011.
The study found that only half (52%) of women eligible for the corticosteroid treatment who gave birth at 26-34 weeks gestation received them prior to delivery in the participating hospitals. Rates of corticosteroid use ranged from 16% of eligible women in Afghanistan and the Democratic Republic of the Congo to 91% in Jordan. More than one-quarter (27%) of the women who were eligible to receive tocolytic drugs were treated with bed rest or hydration, which are ineffective, and half (48%) received no treatment at all. Fewer than one in five (18%) women in the study who could have been given tocolytic drugs and antenatal corticosteroids actually received both.
All women in pre-term labour who are between 26 and 34 weeks pregnant in hospitals with access to newborn care should be getting corticosteroids. They are one of the most effective, safe and inexpensive treatments for reducing newborn deaths and disability, says Dr Marleen Temmerman, Director of WHO’s Department of Reproductive Health and Research and co-author of the study. More than three-quarters of pre-term babies born in hospitals could be saved with cost-effective interventions like corticosteroids to the pregnant woman before she gives birth. This is particularly important in Africa and Asia where more than 60% of pre-term deliveries occur, where resources are scarce and it is difficult to provide additional expensive neonatal drugs.
More than one in ten babies around the world are born too early, adding up to some 15 million births each year. Pre-term birth is the largest cause of death among newborn babies, and complications of pre-maturity kill around one million children annually. Complications of pre-term birth include respiratory distress syndrome, bleeding in the brain, and long-term health conditions such as learning disabilities and poor motor skills.
Dexamethasone and betamethasone are the most commonly used antenatal corticosteroids for lung maturation. The WHO is currently updating its guidelines on prevention and management of pre-term birth. These are expected to be published in 2015.
In 2012, the UN Commission on Life-saving Commodities for Women and Children recommended that countries make both drugs available to all those in need. Dexamethasone is included on the WHO Model List of Essential Medicines (which serves as a model for the selection and use of medicines in countries).
Nifedipine is a relatively cheap, simple to administer, tocolytic drug. It is also included on the WHO Essential Medicines List. The study’s authors emphasise that dexamethasone and betamethasone should be included on national essential medicines lists.
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