Dexamethasone associated with lower risk for neonatal death, stillbirth
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When given to women in low-resource countries who are at risk for early preterm birth, dexamethasone can significantly boost the survival of premature babies, data published in The New England Journal of Medicine showed.
“What is happening right now is that, especially in low-resource countries, use of dexamethasone is not that prevalent,” Olufemi T. Oladapo, MBBS, MPH, FWACS, FICS, WHO’s head of maternal perinatal health, told Healio. “The rate is less than 30% in many hospitals, and that is [how] it’s contributed to a large proportion of neonatal deaths among preterm babies. There's a huge disparity between the neonatal deaths that we have seen in high-income countries compared to low-income countries, and even in our study, it's quite, quite high.”
Oladapo and colleagues conducted a multicountry, randomized trial that enrolled pregnant women between 26 weeks, 0 days and 33 weeks, 6 days of gestation at 29 hospitals in Bangladesh, India, Kenya, Nigeria and Pakistan.
From December 2017 to November 2019, a total of 2,852 women were randomly assigned to receive either intramuscular dexamethasone (n = 1,429) or placebo (n = 1,423). According to the study, 90% of infants in the dexamethasone group and 90.8% in the placebo group were delivered within 37 weeks.
Among 1,417 live births in the dexamethasone group, there were 278 neonatal deaths (19.6%), compared with 331 neonatal deaths among 1,406 live births in the placebo group (23.5%) (RR = 0.84; 95% CI, 0.72-0.97). The authors determined that 25 women would need to be treated with dexamethasone in order to prevent one neonatal death (95% CI, 14-110).
The incidence of stillbirths was also lower in the dexamethasone group compared with the placebo group — 25.7% vs. 29.2% (RR, 0.88; 95% CI, 0.78-0.99). Possible maternal bacterial infection was also lower in the dexamethasone group — 4.8% vs. 6.3% (RR, 0.76; 95% CI, 0.56-1.03).
“Not all women will benefit from the drug,” Oladapo told Healio. “[Clinicians] need to think carefully about how to select the woman who get it. If the clinician is not able to determine the gestational age accurately, it’s a possibility it might hurt babies.”