Antenatal corticosteroids for early preterm birth: implementation strategy lessons from the WHO ACTION-I trial.
Ayesha De CostaOlufemi T OladapoShuchita GuptaAnayda PortelaJoshua P VogelJoao Paulo SouzaSuman RaoNicole MinckasÖzge TuncalpRajiv BahlFernando AlthabePublished in: Health research policy and systems (2022)
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.
Keyphrases
- preterm birth
- gestational age
- acute coronary syndrome
- low birth weight
- birth weight
- healthcare
- study protocol
- primary care
- quality improvement
- palliative care
- phase iii
- clinical trial
- pregnant women
- phase ii
- magnetic resonance imaging
- cardiovascular events
- randomized controlled trial
- public health
- risk factors
- type diabetes
- mental health
- coronary artery disease
- open label
- adipose tissue
- double blind
- pain management
- skeletal muscle
- body composition
- chronic pain
- contrast enhanced ultrasound
- affordable care act
- weight gain
- high intensity
- weight loss