ANTENATAL CORTICOSTEROID USE IN PRETERM DELIVERY AT

KENYATTA NATIONAL HOSPITAL

PRINCIPAL INVESTIGATOR: DR. GWAKO G. N

SUPERVISORS: PROF. QURESHI Z.N; DR. KUDOYI W.O; PROF. WERE F.

KNH/UON MNCH SYMPOSIUMUON LT3

10-Jan-2013

  

IntroductionPRETERM birth causes ≥75% of neonatal deaths that are not

attributable to congenital malformations.

ACS given to mothers at risk of preterm birth reduce the incidence and

severity of RDS, IVH, NEC and neonatal deaths.

WHO recommends the use of one course of ACS for all pregnant

women between 26 and 35wks who are at risk of preterm delivery

within 7 days. ACOG and RCOG recommend their use between 24 and

34 weeks of gestation.

The use of ACS after 34 or 35 weeks of gestation is not recommended.

Objectives

To determine the:

frequency of adminstration of ACS

impact of ACS in reducing the incidence and

severity of RDS; NBU admissions and neonatal

deaths in preterm neonates (28- 37 weeks

gestation), born to women with PTL, PPROM or

severe preeclampsia at KNH.

Methods

Site: Kenyatta National Hospital. Study design: cross

sectional

Study population: mothers with preterm birth between

28-37 weeks gestation and their neonates.

Methodology: women who met the inclusion criteria and

consented for the study were recruited sequentially

immediately after delivery. Interviews. Medical records.

Neonates followed up until discharge/death or the 7th day.

Outcome measures: occurrence of RDS, severity of

RDS,NBU/NICU admissions and neonatal deaths

Summary Results

A total of 206 mother/neonate pairs were

recruited.

114(55.4%) mothers had spontaneous preterm

labour, 53(25.1%) had PPROM, 39(18.9%) had

severe pre-eclampsia.

72(34.9%) mothers received antenatal steroids:46 % of those who delivered before 34weeks 26% of those who delivered after 34 weeks

Descriptive analysis of ACS useVariable Category Frequency Percentage

Received steroid (n=206) 

Yes 72 34.9%No 134 65.1%

Steroid received (n= 72)

Dexamethasone

72 100%

Betamethasone  

0 0%

Duration between first dose and delivery (n=72)

0-24hrs 34 47.2%24-48hrs 24 33.3%48-72hrs 3 4.2%>=72hrs 11 15.3%

Number of doses 1 dose 19 26.4%2 doses 45 62.5%3 doses 1 1.4%4 doses 2 2.8%

  Not known 5 

6.9%

Impact of ACS on occurrence of RDS:Any number of ACS doses, any interval

between first dose and delivery(n=206)

28-33weeks 34-37 weeks

overall0

10

20

30

40

50

60

70

80

exposednot exposedColumn1

………...2doses vs no ACS use(n=180)

28-33weeks 34-37weeks overall0

10

20

30

40

50

60

70

80

exposednot exposed

….delivery after 48hrs of ACS exposure vs no exposure(n=147)

28-33weeks

34-37weeks

overall0

10

20

30

40

50

60

70

80

48hrs of exposureno exposureColumn1

Impact of ACS use on oxygen therapyNeed for oxygen therapy(n=201)

28-33 weeks

34-37 weeks

overall0

10

20

30

40

50

60

70

exposedNEColumn1

Need for oxygen therapy >24hours(n =74)

28-33weeks

34-37weeks

overall0

10

20

30

40

50

60

70

80

exposednot exposedColumn1

Impact of ACS use on need for mechanical ventilation(n=206)

28-33weeks 34-37 weeks

0verall0

1

2

3

4

5

6

7

8

9

10

Series 1Series 2Column1

Impact of ACS use on NBU and NICU admissions….NBU admissions(n=198)

28-33weeks

34-37 weeks

0verall0

10

20

30

40

50

60

70

80

90

exposed not exposedSeries 3

…NICU admissions(206)

28-33 weeks

34-37 weeks

overall0

2

4

6

8

10

12

exposednot exposed

……..indications for NBU admission

28-33weeks 34-37weeks0

10

20

30

40

50

60

70

80

E-RDSE-OTHERNE-RDSNE-OTHER

Impact of ACS use on neonatal mortality(n=206)

28-33 weeks

34-37 weeks

overall0

5

10

15

20

25

30

35

40

ExposedNot exposed

Conclusions Exposure to antenatal steroids reduces the

incidence and severity of respiratory distress syndrome and neonatal mortality. This reduction is however more significant in those neonates delivered before 34 weeks of gestation.

Recommendations This study shows that there is no extra benefit

of ACS use after 34 weeks gestation; clinicians should to be sensitized on need to avoid their unnecessary use after this gestation.

During the course of the study it was noted there was no SOP at KNH on use of ACS in terms of which steroids to use, dosage and number of courses to be administered. It will be important for KNH to develop such a protocol.

ACS are effective and yet underutilized.

THANK YOU.