A review of the benefits of antenatal steroids in premature neonates in a middle income country
Date
2017
Authors
Laher Anees
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Abstract
Background: Antenatal corticosteroids have become a standard of practice. However, there
is low antenatal corticosteroid coverage in low-middle-income countries. Recent studies have
questioned the efficacy of antenatal corticosteroids in low-middle-income countries.
Objectives: To review the use of ANS in preterm neonates at Charlotte Maxeke
Johannesburg Academic Hospital.
Methods: This study was a retrospective observational study. The population included all
neonates, with a birth weight of 500-1800 grams, born at Charlotte Maxeke Johannesburg
Academic Hospital between I January 2013 and 30 June 2016. Neonatal and maternal
characteristics of neonates exposed to antenatal corticosteroids were compared to those who
were not exposed to antenatal steroids.
Results: The antenatal corticosteroid coverage of the final sample was 930/2109 (44.1 %).
The mean birth weight was 1292.4 grams (SO323.2) and the mean gestational age was 30.2
weeks (SD2.9). Antenatal care and maternal hypertension were associated with increased use
of antenatal corticosteroids, whereas vaginal delivery was associated with decreased antenatal
corticosteroid use. In neonates, the use of antenatal corticosteroids was associated with
decreased mortality, decreased intraventricular haemorrhage, and decreased patent ductus
arteriosus in neonates < 1500 grams. There was no association between antenatal
corticosteroids and respiratory distress syndrome, necrotizing enterocolitis, sepsis, and need
for respiratory support in all premature neonates and there was no association with improved
outcomes in babies ~ 1500 grams.
Conclusion: The benefits associated with neonatal morbidity in the current study were not as
marked as those published in high-income countries. Perhaps, a randomized control trial is
indicated in low-middle-income countries.
Description
Submitted to the Department of Paediatrics and Child Health, University of Witwatersrand, Johannesburg,