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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Antenatal steroids in preterm labour for the prevention of neonatal deaths due to complications of preterm birth
International Journal of Epidemiology, Volume 39, No. SUPPL. 1, Year 2010
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Description
Background: In high-income countries, administration of antenatal steroids is standard care for women with anticipated preterm labour. However, although 41 million deaths due to preterm birth occur annually, antenatal steroids are not routine practice in low-income countries where most of these deaths occur. Objectives: To review the evidence for and estimate the effect on cause-specific neonatal mortality of administration of antenatal steroids to women with anticipated preterm labour, with additional analysis for the effect in low- and middle-income countries. Methods: We conducted systematic reviews using standardized abstraction forms. Quality of evidence was assessed using an adapted GRADE approach. Existing meta-analyses were reviewed for relevance to low/middle-income countries, and new meta-analysis was performed. Results: We identified 44 studies, including 18 randomised control trials (RCTs) (14 in high-income countries) in a Cochrane meta-analysis, which suggested that antenatal steroids decrease neonatal mortality among preterm infants (<36 weeks gestation) by 31% [relative risk (RR)=0.69; 95% confidence interval (CI) 0.58-0.81]. Our new meta-analysis of four RCTs from middle-income countries suggests 53% mortality reduction (RR=0.47; 95% CI 0.35-0.64) and 37% morbidity reduction (RR=0.63; 95% CI 0.49-0.81). Observational study mortality data were consistent. The control group in these equivalent studies was routine care (ventilation and, in many cases, surfactant). In low-income countries, many preterm babies currently receive little or no medical care. It is plausible that antenatal steroids may be of even greater effect when tested in these settings. Conclusions: Based on high-grade evidence, antenatal steroid therapy is very effective in preventing neonatal mortality and morbidity, yet remains at low coverage in low/middle-income countries. If fully scaled up, this intervention could save up to 500 000 neonatal lives annually. © The Author 2010; all rights reserved.
Authors & Co-Authors
Mwansa-Kambafwile, Judith R.M.
Unknown Affiliation
Cousens, Simon Nicholas
Unknown Affiliation
Hansen, Thomas
Unknown Affiliation
Lawn, Joy E.
Unknown Affiliation
Statistics
Citations: 159
Authors: 4
Affiliations: 7
Identifiers
Doi:
10.1093/ije/dyq029
ISSN:
03005771
e-ISSN:
14643685
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Randomised Control Trial
Study Approach
Systematic review
Participants Gender
Female