Trial finds medication to save premature babies

THE results of a new clinical trial, published on Friday in the “New England Journal of Medicine”, show that dexamethasone – a glucocorticoid used to treat many conditions, including rheumatic problems and severe Covid-19 – can boost the survival of premature babies when given to pregnant women at risk of preterm birth in low-resource settings.
The World Health Organisation (WHO) action-I trial resolved an ongoing controversy about the efficacy of antenatal steroids for improving preterm newborn survival in low-income countries.
Dexamethasone and similar drugs have long shown to be effective in saving preterm babies’ lives in high-income countries, where high-quality newborn care is more accessible.
This is the first time a clinical trial has proven that the drugs are effective in low-income settings.
The impact is significant: For every 25 pregnant women treated with dexamethasone, one premature baby’s life was saved.
When administered to mothers at risk of preterm birth, dexamethasone crossed the placenta and accelerated lung development, making it less likely for preterm babies to have respiratory problems at birth.
Globally, prematurity is the leading cause of death in children under the age of five.
Every year, an estimated 15 million babies are born too early, and one million die due to complications resulting from their early birth.
In low-income settings, half of the babies born at or below 32 weeks die due to a lack of feasible, cost-effective care.
The study noted that healthcare providers should have the means to select the women most likely to benefit from the drug and to initiate the treatment at the right time – ideally 48 hours before giving birth to give enough time to complete steroid injections for maximal effect.
Women who are in weeks 26-34 of their pregnancy are most likely to benefit from the steroid, so healthcare providers should have access to ultrasound to accurately date their pregnancies.
In addition, babies should receive sufficiently good-quality care when they are born.
Conducted from December 2017 to last November, the randomised trial recruited 2,852 women and their 3,070 babies from 29 secondary and tertiary level hospitals in Bangladesh, India, Kenya, Nigeria and Pakistan. Beyond finding a significantly lower risk of neonatal death and stillbirth, the study found there was no increase in possible maternal bacterial infections when treating pregnant women with dexamethasone.