A review of the benefits of antenatal steroids in premature neonates in a middle income country

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.