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

journal contribution
posted on 2023-08-25, 03:29 authored by A De Costa, OT Oladapo, S Gupta, A Portela, Josh VogelJosh Vogel, JP Souza, S Rao, N Minckas, Ö Tuncalp, R Bahl, F Althabe
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.

History

Journal

Health Research Policy and Systems

Volume

20

Article number

141

Pagination

141-

Location

England

ISSN

1478-4505

eISSN

1478-4505

Language

en

Issue

1

Publisher

Springer Science and Business Media LLC