The use of Antenatal corticosteroids and outcomes of premature neonates at the University Teaching Hospital, Lusaka,Zambia
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Background: Following the administration of corticosteroids to pregnant women at risk of premature delivery, the occurrence of hyaline membrane disease and the related complications among neonates born of such women is significantly reduced. Despite this knowledge, the use of corticosteroids in developing countries remains low. This study aimed to determine the outcome of premature babies whose mothers were administered corticosteroids antenatally, and understand how health-staff used corticosteroids at the University Teaching Hospital (UTH). Methods: The research had two components with two research designs: a prospective cohort to study outcomes of premature babies in intensive care unit (NICU) whose mothers were administered dexamethasone antenataly and a cross section study to evaluate the use of corticosteroids amongst staff in the maternity unit at UTH. The prospective component measured clinical diagnosis of respiratory distress syndrome (RDS), necrotising enterocolitis (NEC), intra-ventricular haemorrhage (IVH) and sepsis in the neonate. The cross section component measured knowledge regarding antenatal corticosteroids, factors affecting use of dexamethasone and prescription trends.Results: More than two-thirds (68%) of the enrolled neonates were delivered less than 24 hours after dexamethasone had been administered to the mother. The neonates that had birth weight less 2000 grams were 76%. Over half (58%) of enrolled neonates were delivered due to premature labour without an identifiable cause. The incidence of RDS was 25.9% (95% CI 20.03-31.77); sepsis was also 25.9% (95% CI 20.03 – 31.77). Almost half the neonates had no complications (47%; 95% CI 41.13 – 52.87). There was only one case of NEC and there was no occurrence of IVH recorded. The occurrence of complications among neonates whose mothers received the 6 mg regimen and those who received the 12 mg was 56.8% and 45.2% respectively. The occurrence of RDS was 29% among neonates whose mothers received regime 6mg and 12% among those who received 12mg. The maternal HIV-status (18%) was similar to the prevalence in the general population and HIV status was not associated with neonatal complications. Delivery by caesarean section seemed to have a higher occurrence of RDS (29.2%) than delivery by SVD (22.8%). The incidence of very low Apgar score for neonates delivered by SVD was 12.3% and 4% for babies born by caesarean section. During the same period, 56 health-workers were interviewed. The three major factors affecting the non-use of dexamethasone were shortage of the drug (37.5%), patients coming in advanced labour (21.4%) and health workers forgetting to prescribe (10.7%). The prevalence of above average knowledge regarding the use of corticosteroids in pregnancy among health-workers was 93.6%. Conclusions: The neonatal complication rate in neonates whose mothers had received antenatal corticosteroids was high, at 53%. However, the majority of deliveries occurred less than 24 hours before dexamethasone could take effect. Apart from the use of corticosteroids, several other factors affect the outcomes of babies born premature. Problems of the health system, compounded by either health-workers’ forgetfulness or substandard-care, were the major factors affecting the non-use of antenatal corticosteroids.
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