Saving preterm babies with simple steroid

Preterm births (birth before 37 weeks of pregnancy) is the biggest killer of babies worldwide, causing more than one million deaths per year. In Bangladesh, the complications arising from preterm deliveries contribute 45% of all newborn deaths.

Corticosteroids, an inexpensive drug given before birth have long been considered very effective to significantly lower preterm infants' risk of death, breathing problems, bleeding in the brain, and long-term complications such as cerebral palsy and poor motor skills. Yet, only half of eligible women in low- and middle-income countries like Bangladesh at risk for preterm birth receive the drug that seems to help prevent complications and deaths in premature infants, according to a recently published study in The Lancet.

Corticosteroids are a class of drugs which can reduce the risk of newborn deaths by more than 53%  in facilities where ventilation support is not available and by roughly 30% even where advanced Neonatal Intensive Care Units (NICUs) are available. These drugs are among the best documented, most effective, safest, and least expensive interventions to reduce preterm deaths. Antenatal corticosteroids have been included in UN Commission on Life-Saving Commodities for Women and Children as an essential medicine that should be available everywhere. When this drug is administered to the woman, it accelerates lung maturation of the growing baby while it is still in the womb. If the baby has more mature lungs at birth s/he is less likely to suffer from breathing problems, and thus more likely to survive. These have also been shown to have a protective effect on the cerebral blood vessels, and intestine, thus reducing the risk of bleeding into brain as well as reducing the chance of fatal infection to gut. 

Fluid leaking from the vagina, painful contractions, vaginal bleeding or signs of pre-eclampsia like swelling of leg and high blood pressure and convulsion are the symptoms that signal labour.

If these occur well ahead her expected delivery date within 24 weeks to 37 weeks, the pregnant woman should be considered an ideal candidate for corticosteroid and should consult a healthcare professionals in nearby facility. Even if there is not sufficient time before delivery for a full course of dexamethasone, experts recommend giving at-least first dosage immediately and then give as many additional doses (until four) as time allows. Even less than a full course of the medication will benefit the baby.

Preterm delivery occurs in 14% pregnancies in Bangladesh and is associated with a number of medical complications that may need advance medical care and require re-hospitalisation. It impinges a huge economic burden for the family, society and as a whole the country. Estimates show that more than three-quarters of premature babies could be saved with cost-effective interventions like steroid. And this is particularly important in Bangladesh, where resources are scarce and it is difficult to provide expensive neonatal care.

It is quiet unfortunate that a significant number of premature infants are dying and being disabled despite the simple solution in our hands. A little awareness could save these infants from early grave.