Effectiveness of antenatal dexamethasone in reducing respiratory distress syndrome and mortality in preterm neonates: a nested case control study
Javier Amador-Casta?eda, BHS, RRT, FCCM, PNAP
| Respiratory Care Practitioner | Author | Speaker | Veteran | ESICM Representative, North America
Kibanga, W., Mutagonda, R.F., Moshiro, R. et al. Effectiveness of antenatal dexamethasone in reducing respiratory distress syndrome and mortality in preterm neonates: a nested case control study. BMC Pediatr 23, 94 (2023). https://doi.org/10.1186/s12887-023-03887-5
Summary of "Effectiveness of antenatal dexamethasone in reducing respiratory distress syndrome and mortality in preterm neonates: a nested case-control study"
Summary:
This study evaluates the effectiveness of antenatal dexamethasone (ACS) in reducing respiratory distress syndrome (RDS) and neonatal mortality in preterm neonates in a low-resource setting in Tanzania. Through a nested case-control design, the study assessed the association between ACS exposure and neonatal outcomes among neonates born between 28 to 34 gestational weeks. Results revealed that while ACS was associated with reduced mortality, it had no statistically significant impact on RDS occurrence. Factors such as gestational age, birth weight, and Apgar scores emerged as critical predictors of neonatal outcomes.
Key Points:
1. Study Design: A nested case-control study involving 330 preterm neonates, with 110 cases (RDS occurrence) and 220 controls (no RDS).
2. ACS and RDS: ACS exposure did not significantly reduce the odds of RDS (AOR: 1.65, 95% CI 0.86–3.15, p = 0.129).
3. Mortality Rates: Mortality was lower in neonates exposed to ACS (4 per 1000) compared to those unexposed (13 per 1000), but this association was not statistically significant in multivariate analysis.
4. Gestational Age Impact: Each additional week of gestational age reduced the odds of RDS by 19% and neonatal mortality by 30%.
5. Birth Weight Influence: Higher birth weight was associated with decreased risks of RDS and mortality.
6. Apgar Scores: Neonates with a 1-minute Apgar score < 7 were three times more likely to develop RDS than those with scores ≥ 7.
7. RDS Diagnosis: Silverman Anderson Scores were used to diagnose and assess RDS severity.
8. Maternal Comorbidities: Neonates of mothers with non-communicable diseases had lower mortality rates, potentially due to improved antenatal care.
9. Mode of Delivery: Caesarean section reduced mortality rates compared to spontaneous vaginal delivery in very preterm neonates.
10. Contextual Challenges: Limited neonatal care facilities and delayed antenatal visits in resource-limited settings may impact ACS effectiveness.
Conclusion:
While antenatal dexamethasone showed potential in reducing neonatal mortality, it did not significantly affect RDS occurrence. Gestational age, birth weight, and Apgar scores were strong predictors of neonatal outcomes. Further studies are needed to refine ACS protocols and address contextual challenges in low-resource settings.
Watch the following video on "Antenatal Corticosteroids: The Good, the Bad and the Unknown" by Hologic, Inc.
Discussion Questions:
1. How can antenatal corticosteroid protocols be optimized to enhance their effectiveness in reducing RDS and mortality in low-resource settings?
2. What strategies can improve access to comprehensive neonatal care facilities in resource-limited regions?
3. How can maternal comorbidities and antenatal care utilization influence neonatal outcomes, and what role does ACS play in this context?
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.