Utilization of Antenatal Corticosteroids for Improving Neonatal Outcomes in Kenyatta National Hospital

Abstract

Background: Antenatal corticosteroids (ACS) are well recognized as a key mediator in decreasing the adverse complications of preterm birth. Preterm newborns are more likely to experience both short-term and long-term morbidities, with RDS being one of the most serious. Only 35% of prenatal corticosteroids were used in Kenyatta National Hospital (KNH), according to Gwako et al. Guideline changes are expected to result in increased ACS use, however no follow up study has been done to assess the current utilization of antenatal corticosteroids at KNH and identification of factors that may affect its use. Objectives: To determine the proportion of women who delivered in KNH between 24-37 weeks and received antenatal corticosteroids and to describe factors associated with its utilization as well as the neonatal short-term outcomes. Study Methods: A cross-sectional descriptive study in Kenyatta National Hospital NBU/NICU and postnatal wards that recruited women and their preterm neonates delivered at Kenyatta National Hospital. Outcome measures included frequency of antenatal corticosteroids administration, need for NBU admission, need for respiratory support and prevalence of neonatal deaths. Factors associated with antenatal corticosteroid administration were determined by the calculation of the Risk Ratio (RR) and 95% confidence intervals (CI) with a level of statistical significance set at 0.05. Multivariate analysis was carried out to adjust for confounders. Results: Of 384 women, 171 (45%) received antenatal corticosteroids (95% CI 39.6% - 49.5%). Antenatal corticosteroids were prescribed in 251 of women recruited, but was administered to 171 women .The greatest discrepancy between prescription and administration was seen in the 29–32-week group. Multivariate analysis to adjust for confounders revealed that women with a gestational age ≤34 weeks (ARR 2.37 95% CI 1.69 – 3.32; p=<0.001) and the presence of comorbidities (ARR 1.38 95% CI 1.10 – 1.75; p=0.006) were more likely to receive antenatal corticosteroids, while women who presented with the presence of labour at admission (ARR 0.74 95% CI 0.58 – 0.95; p=0.018) were less likely to receive antenatal corticosteroids and these were statistically significant In newborns exposed to prenatal corticosteroids, 93 % required admission to the NBU/NICU, 46 % required oxygen, 32 % required CPAP, 12 % required mechanical breathing, 23 % required surfactant, and 20 % of the neonates died during the first seven days of life. Conclusion: Antenatal corticosteroids are underutilized in women who deliver preterm in KNH between 24-37 weeks. Fewer women receive antenatal corticosteroids than those to whom it is prescribed. Comorbid conditions and a gestational age of less than 34 weeks were linked to higher prenatal corticosteroid utilization, whereas labor at the time of admission was linked to lower antenatal corticosteroid utilization. Recommendations: There is need to increase the utilization of antenatal corticosteroids in KNH. Further study is needed to identify gaps in administration of antenatal corticosteroids following its prescription.