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dc.contributor.author
McClure, Elizabeth M.
dc.contributor.author
Goldenberg, Robert L.
dc.contributor.author
Jobe, Alan H.
dc.contributor.author
Miodovnik, Menachem
dc.contributor.author
Koso Thomas, Marion
dc.contributor.author
Buekens, Pierre
dc.contributor.author
Belizan, Jose
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dc.contributor.author
Althabe, Fernando
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dc.date.available
2018-05-14T18:58:58Z
dc.date.issued
2016-05
dc.identifier.citation
McClure, Elizabeth M.; Goldenberg, Robert L.; Jobe, Alan H.; Miodovnik, Menachem; Koso Thomas, Marion; et al.; Reducing neonatal mortality associated with preterm birth: gaps in knowledge of the impact of antenatal corticosteroids on preterm birth outcomes in low-middle income countries; BioMed Central; BMC Public Health; 13; 1; 5-2016; 1-4
dc.identifier.issn
1742-4755
dc.identifier.uri
http://hdl.handle.net/11336/45123
dc.description.abstract
The Global Network’s Antenatal Corticosteroids Trial (ACT), was a multi-country, cluster-randomized trial to improve appropriate use of antenatal corticosteroids (ACS) in low-resource settings in low-middle income countries (LMIC). ACT substantially increased ACS use in the intervention clusters, but the intervention failed to show benefit in the targeted < 5th percentile birth weight infants and was associated with increased neonatal mortality and stillbirth in the overall population. In this issue are six papers which are secondary analyses related to ACT that explore potential reasons for the increase in adverse outcomes overall, as well as site differences in outcomes. The African sites appeared to have increased neonatal mortality in the intervention clusters while the Guatemalan site had a significant reduction in neonatal mortality, perhaps related to a combination of ACS and improving obstetric care in the intervention clusters. Maternal and neonatal infections were increased in the intervention clusters across all sites and increased infections are a possible partial explanation for the increase in neonatal mortality and stillbirth in the intervention clusters, especially in the African sites. The analyses presented here provide guidance for future ACS trials in LMIC. These include having accurate gestational age dating of study subjects and having care givers who can diagnose conditions leading to preterm birth and predict which women likely will deliver in the next 7 days. All study subjects should be followed through delivery and the neonatal period, regardless of when they deliver. Clearly defined measures of maternal and neonatal infection should be utilized. Trials in low income country facilities including clinics and those without newborn intensive care seem to be of the highest priority.
dc.format
application/pdf
dc.language.iso
eng
dc.publisher
BioMed Central
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dc.rights
info:eu-repo/semantics/openAccess
dc.rights.uri
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.subject
Neonatal Mortality
dc.subject.classification
Medicina Critica y de Emergencia
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dc.subject.classification
Medicina Clínica
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dc.subject.classification
CIENCIAS MÉDICAS Y DE LA SALUD
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dc.title
Reducing neonatal mortality associated with preterm birth: gaps in knowledge of the impact of antenatal corticosteroids on preterm birth outcomes in low-middle income countries
dc.type
info:eu-repo/semantics/article
dc.type
info:ar-repo/semantics/artículo
dc.type
info:eu-repo/semantics/publishedVersion
dc.date.updated
2018-05-11T20:39:04Z
dc.journal.volume
13
dc.journal.number
1
dc.journal.pagination
1-4
dc.journal.pais
Reino Unido
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dc.journal.ciudad
Londres
dc.description.fil
Fil: McClure, Elizabeth M.. RTI International; Estados Unidos
dc.description.fil
Fil: Goldenberg, Robert L.. Columbia University; Estados Unidos
dc.description.fil
Fil: Jobe, Alan H.. Cincinnati Children’s Hospital; Estados Unidos
dc.description.fil
Fil: Miodovnik, Menachem. Eunice Kennedy Shriver National Institute of
Child and Human Development; Estados Unidos
dc.description.fil
Fil: Koso Thomas, Marion. Eunice Kennedy Shriver National Institute of
Child and Human Development; Estados Unidos
dc.description.fil
Fil: Buekens, Pierre. University of Tulane; Estados Unidos
dc.description.fil
Fil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
dc.description.fil
Fil: Althabe, Fernando. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
dc.journal.title
BMC Public Health
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dc.relation.alternativeid
info:eu-repo/semantics/altIdentifier/doi/https://dx.doi.org/10.1186/s12978-016-0180-6
dc.relation.alternativeid
info:eu-repo/semantics/altIdentifier/url/https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-016-0180-6
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