A decade of experience with use of antenatal corticosteroids in preterm birth: Maternal and neonatal outcomes in the resource constraint setting of Maiduguri, North-Eastern Nigeria

Abstract

Background: According to the American College of Obstetrics and Gynaecology (ACOG) and American Academy of Pediatrics (AAP), administration of antenatal corticosteroids to the woman who is at risk of imminent preterm delivery is strongly associated with decreased neonatal morbidity and mortality. It enhances lung maturity and surfactant production. Surfactant is phospholipid/ glycoprotein molecule that is produced by type II pneumocytes in the alveolar sacs between 22 and 28 weeks gestation. Also following
preterm birth, there is poor lung fluid absorption that further compounds the preterm baby’s smooth transition from intrauterine life to extra-uterine life.
Objective: To review the beneficial effect of antenatal corticosteroids (dexamethasone) use among pregnant mothers presenting with imminent preterm birth at labour ward and admitted at special care baby unit of University of Maiduguri Teaching Hospital over a ten-year period (2012 to 2022).
Subjects and method: Over the ten year period, case notes of 425 women who had preterm birth with complete information were retrieved and analyzed after obtaining ethical clearance from the hospital’s ethics and research committee. The study was conducted in accordance with Helsinki declaration of 2013 as amended.
Result: During the 10-year study period, 21,458 births were recorded and of these, 425 deliveries were below 37 completed weeks, and benefitted from treatment with antenatal corticosteroid. The preterm births had benefitted from at least two doses of dexamethasone  at dose of 6 mg 12 hourly, with prevalence of (2.3%). before birth. There was improved APGAR score (≥7 at one and five minutes). Respiratory distress syndrome, and necrotizing enterocolitis were equally low.
Conclusion: Antenatal corticosteroid administration in preterm birth (2.3%) was very low. Similar observation has also been made across Nigeria and other (LMIC) low middle income countries. Dexamethasone use in preterm birth had proven beneficial in improving survival among preterm babies and thereby reducing the duration of hospitalization. We are suggesting further research in the use of antenatal/prenatal dexamethasone in imminent preterm birth.