Abstract:
Background: Respiratory distress syndrome (RDS) is a significant cause of preterm neonatal
morbidity and mortality globally. Measures like the use of antenatal corticosteroids (ACS) and
immediate resuscitation of the newborn after birth are taken to abate preterm related
complications. Most studies that evidenced the benefit of ACS were done in high resource
settings. However, some studies in low resource settings reported no benefit of ACS in
improving neonatal outcomes. Such findings warrant for further studies in different settings.
Aim: To assess the effectiveness of antenatal dexamethasone in reducing RDS and mortality in
preterm neonates in Dar es Salaam, Tanzania.
Methods: A three-month nested case-control study was conducted in Dar es Salaam at
Muhimbili National Hospital and Amana Regional Referral Hospital. A total of 330 neonates
delivered at 28 to 34 gestational weeks were enrolled consecutively and followed up through
the study period. RDS was diagnosed within 48 h after birth. Cases were neonates with RDS
and controls were those without. Maternal and neonatal socio-demographic and clinical data
were recorded using a data abstraction forms. Proportions were used to summarize descriptive
statistics. Overall mortality rate was calculated using incidence rate. Log ranking test and cox
regression were used to graphically compare probability of death with time and measure
association, respectively. Continuous variables were summarized using median and range then
analyzed by Mann-Whitney U test. All tests were considered statistically significant at p <0.05.
Results: Out of 330 preterm neonates enrolled, of which 110 were cases and 220 were controls.
71.8% of the participants were from MNH and 28.2% from Amana regional referral hospital.
The median gestational age at delivery was 30 weeks and 6 days (28-34) among cases and 33
weeks (28-34) among controls (p<0.001). A one-minute APGAR score of less than seven was
assigned to 38.2% of cases compared to 14.5% of controls (p<0.001).
ACS exposure was not associated with RDS occurrence (OR: 0.81; 95% CI 0.69-0.94), one minute APGAR score of less than 7 (OR: 3.11; 95% CI 1.54-6.30), and neonatal birth weight (OR: 0.998; 95% CI 0.997-0.999) were significantly associated with RDS. The overall mortality
rate was 9 per 1000 neonates. Neonatal mortality occurred only among cases. A unit increase in
gestational age was associated with a 30% reduction in neonatal mortality (Adjusted hazard
ratio, AHR: 0.70, 95% CI: 0.5-0.92, p=0.011).
Conclusion: Antenatal dexamethasone is not associated with reduced RDS occurrence and
neonatal mortality rates. Increase in gestational age is found to be an independent protective
factor against RDS and neonatal mortality. One-minute APGAR score of < 7 and low neonatal
birth weights are independent predictors of RDS in preterm neonates
