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

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Global Health

Background:

• The WHO ACTION-I trial is the largest placebo-controlled study on antenatal corticosteroids (ACS).
• ACS demonstrated significant benefits in reducing mortality for early preterm newborns, particularly in low-income settings.

Purpose of the Study:

• To discuss lessons learned from the ACTION-I trial for optimizing antenatal corticosteroid (ACS) implementation.
• To present a strategy for effective ACS administration to reduce neonatal mortality.

Main Methods:

• Utilized gestational age dating via ultrasound.
• Applied selection criteria by trained obstetric physicians for identifying women at risk of preterm birth.
• Ensured a minimum care package for preterm newborns in healthcare facilities.

Main Results:

• The implementation strategy successfully identified women likely to deliver preterm.
• A 16% reduction in neonatal mortality was achieved through antenatal corticosteroid (ACS) use.
• The strategy demonstrated the efficacy and safety of ACS in real-world settings.

Conclusions:

• Effective implementation of antenatal corticosteroids (ACS) requires accurate gestational age dating and appropriate patient selection.
• Integrating ACS with essential newborn care maximizes its impact on reducing preterm birth mortality.
• Policy-makers and clinicians should adopt this strategy to scale ACS benefits and save preterm infant lives.