Antenatal corticosteroids for early preterm birth: implementation strategy lessons from the WHO ACTION-I trial

Health Research Policy and Systems

Opinion

Ayesha De Costa¹  Suman Rao¹  Shuchita Gupta¹  Nicole Minckas¹  Joao Paulo Souza¹  Anayda Portela¹  Rajiv Bahl¹  Joshua P. Vogel²  Fernando Althabe³  Olufemi T. Oladapo³  Özge Tuncalp³ 

[1] Department of Maternal, Newborn, Child, Adolescent Health, and Ageing, World Health Organization, 20 Avenue Appia, Geneva, Switzerland;Maternal, Child and Adolescent Health Program, Burnet Institute, The Macfarlane Burnet Institute for Medical Research and Public Health Ltd, 85 Commercial Road, 3004, Melbourne, VIC, Australia;UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, Geneva, Switzerland;

关键词: Preterm birth;    Neonatal mortality;    Antenatal corticosteroids;   

DOI  :  10.1186/s12961-022-00941-z

 received in 2022-08-01, accepted in 2022-11-15,  发布年份 2022

来源: Springer

【 摘 要 】

The WHO ACTION-I trial, the largest placebo-controlled trial on antenatal corticosteroids (ACS) efficacy and safety to date, reaffirmed the benefits of ACS on mortality reduction among early preterm newborns in low-income settings. We discuss here lessons learned from ACTION-I trial that are relevant to a strategy for ACS implementation to optimize impact. Key elements included (i) gestational age dating by ultrasound (ii) application of appropriate selection criteria by trained obstetric physicians to identify women with a likelihood of preterm birth for ACS administration; and (iii) provision of a minimum package of care for preterm newborns in facilities. This strategy accurately identified a large proportion of women who eventually gave birth preterm, and resulted in a 16% reduction in neonatal mortality from ACS use. Policy-makers, programme managers and clinicians are encouraged to consider this implementation strategy to effectively scale and harness the benefits of ACS in saving preterm newborn lives.

【 授权许可】

CC BY   
© © World Health Organization 2022 2022