Antenatal corticosteroids for early preterm birth: implementation strategy lessons from the WHO ACTION-I trial

DE COSTA, AYESHA; OLADAPO, OLUFEMI T.; GUPTA, SHUCHITA; PORTELA, ANAYDA; VOGEL, JOSHUA P.; SOUZA, JOAO PAULO; RAO, SUMAN; MINCKAS, NICOLE; TUNCALP, ÖZGE; BAHL, RAJIV; ALTHABE, FERNANDO

Health Research Policy and Systems

BioMed Central Ltd

Año: 2022 vol. 20

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.