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ANTENATAL CORTICOSTEROID USE IN PRETERM DELIVERY AT K ENYATTA N ATIONAL H OSPITAL

ANTENATAL CORTICOSTEROID USE IN PRETERM DELIVERY AT K ENYATTA N ATIONAL H OSPITAL. PRINCIPAL INVESTIGATOR: DR . GWAKO G. N CO-INVESTIGATORS: PROF. QURESHI Z.N; DR. KUDOYI W.O; PROF. WERE F. Introduction.

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ANTENATAL CORTICOSTEROID USE IN PRETERM DELIVERY AT K ENYATTA N ATIONAL H OSPITAL

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  1. ANTENATAL CORTICOSTEROID USE IN PRETERM DELIVERY AT KENYATTA NATIONAL HOSPITAL PRINCIPAL INVESTIGATOR:DR. GWAKO G. N CO-INVESTIGATORS: PROF. QURESHI Z.N; DR. KUDOYI W.O; PROF. WERE F.

  2. Introduction • PRETERM 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 unless there is evidence of fetal pulmonary immaturity. • Despite this, ACS are widely used locally across all gestational periods.

  3. Objective • To determine the: • frequency of adminstrationof ACS • impact of ACS in reducing the incidence and severity of RDS; NBU/NICU admissions and neonatal deaths in preterm neonates (28- 37 weeks gestation), born to women with PTL, PPROM or severe preeclampsia at KNH.

  4. 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 done and medical records scrutinized. information gathered filled in a structured questionnaire. The neonates were followed up until discharge/death or the 7th day. • Outcome measures: occurrence of RDS, severity of RDS,NBU/NICU admissions and neonatal deaths

  5. Results:Summary • 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 received ACS • 26% of those who delivered after 34 weeks received ACS.

  6. Summary Results cont’d • Dexamethasone was the only ACS used at KNH. • Only 2 (3%)mothers received a complete course of ACS. • ACS significantly reduced the occurrence and severity of RDS in preterm neonates born <34 weeks gestation: • 69% of neonates not exposed to ACS developed RDS • 38% of those exposed developed RDS. • no statistical difference between the two groups among neonates delivered after 34 weeks • 40% among those exposed • 36.8% of those who were not exposed • ACS reduced neonatal mortality of preterm neonates across all gestational ages. • The impact was more in those delivered before 34weeks (11.5% reduction in mortality) compared to those delivered > 34 weeks (5.8% reduction in mortality). • ACS did not reduce the prevalence of NBU and NICU admissions.

  7. Table 1: sociodemographc characteristics

  8. Table 2: Obstetric characteristics of participants

  9. Table 3:Descriptive analysis of ACS use

  10. Table 4:ACS use by gestational age

  11. Table 5: Impact of ACS on occurrence of RDS

  12. Impact cont’d

  13. Impact contd

  14. Table 6: Impact of ACS use on oxygen therapy

  15. Table 6 cont’d

  16. Table 7: Impact of ACS use on need for mechanical ventilation

  17. Table 8: Impact of ACS use on NBU and NICU admissions

  18. Nicu admission

  19. Table 9: indications for NBU admission

  20. Table 10: Impact of ACS use on neonatal mortality

  21. 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.

  22. Recommendations • This study shows that there is no extra benefit of ACS use after 34 weeks gestation; therefore 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.

  23. THANK YOU.

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