Preterm infants in Tanzania had a better survival rate when they had access to resources that improve lung function and combat infections and hypothermia, according to a pilot study.
The resources were part of a low-cost care bundle aimed at reducing mortality rates in a country were about 9,500 preterm infants die each year.
“Providing a realistic way for providers — and especially midwives — to tangibly make a difference in helping premature babies survive is both exciting and extremely rewarding,” study author Jeffrey M. Perlman, M.B., Ch.B. FAAP, professor of pediatrics and chief of newborn medicine for Weill Cornell Medicine, said in a news release. “If the findings can be replicated in other resource-limited settings, the ability to further reduce the less than 5 year mortality rate globally is enormous.”
Dr. Perlman, principal investigator for the Academy’s Helping Babies Breathe project in the Eastern Cape of South Africa, previously found the program was linked to a 47% reduction in early neonatal mortality within 24 hours in Tanzania. He and his team set out to look at additional interventions and conducted a pilot study at four hospitals in Tanzania. Their results are detailed in the report “A care bundle including antenatal corticosteroids reduces preterm infant mortality in Tanzania a low resource country,” (Massawe A, et al. PLoS One. March 7, 2018, http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0193146).
Care was provided to mothers and their infants with gestational ages of 28 weeks to 34 6/7 weeks. The bundle consisted of antenatal corticosteroids, maternal antibiotics during labor, implementation of Helping Babies Breathe, neonatal antibiotics and avoidance of hypothermia. The medications cost about $6 to $7 for each mother and child.
During implementation from June 2015 to June 2017, 362 of 2,953 preterm infants died, a 26% reduction compared to the period before implementation. Fresh stillbirths also dropped by 33%.
Infants who died had a lower birthweight and gestational age than those who survived and were more likely to present with mild hypothermia. The care bundle did not make a statistically significant difference for the youngest preterm infants but reduced mortality by 45% among preterm infants with higher gestational age.
Implementation of the bundle varied across hospitals. When the steroids were used alone, there was a nonsignificant increase in mortality. The combination of steroids and maternal antibiotics without neonatal antibiotics was linked with a statistically significant increased risk of mortality. When both antenatal corticosteroids and neonatal antibiotics were used, mortality dropped 70%.
Authors said the combination of antenatal corticosteroids and antibiotics improved lung development and function, and they stressed the importance of neonatal antibiotics in pre-emptively treating infections.
“This is highly relevant for Tanzania and other resource limited countries, with minimal respiratory support other than oxygen supplementation, and the inability to routinely undertake a basic infectious workup,” authors wrote.
