Trial reportReproductive health2016
The Antenatal Corticosteroids Trial (ACT)'s explanations for neonatal mortality - a secondary analysis.
Trial report in Reproductive health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- Interventions to reduce preterm birth and stillbirth, and improve outcomes for babies born preterm in low- and middle-income countries: A systematic review.Journal of global health · 2021Pooled it
- Strategies for optimising antenatal corticosteroid administration for women with anticipated preterm birth.The Cochrane database of systematic reviews · 2020Pooled it
- Progress Toward the Health-Related Sustainable Development Goals: A Case Study of the Academic Model Providing Access to Healthcare (AMPATH).Journal of general internal medicine · 2026Article
- Article
- Antenatal corticosteroids reduce neonatal mortality in settings without assisted ventilatory support: a retrospective cohort study of early preterm births on the Thailand-Myanmar border.Wellcome open research · 2023Article
- Respiratory Interventions for Preterm Infants in LMICs: A Prospective Study From Cape Town, South Africa.Frontiers in global women's health · 2022Article
- Antenatal corticosteroids: a reappraisal of the drug formulation and dose.Pediatric research · 2021Review
- Antenatal Steroid Utilization in Ethiopia.Global pediatric health · 2021Article
- Prenatal inflammation enhances antenatal corticosteroid-induced fetal lung maturation.JCI insight · 2020Article
- Rates and risk factors for preterm birth and low birthweight in the global network sites in six low- and low middle-income countries.Reproductive health · 2020Article
- An evaluation of the benefits and harms of antenatal corticosteroid treatment for women at risk of imminent preterm birth or prior to elective Caesarean-section: Study protocol for an individual participant data meta-analysis.Wellcome open research · 2020Article
- Dosing and formulation of antenatal corticosteroids for fetal lung maturation and gene expression in rhesus macaques.Scientific reports · 2019Article
- Low-dose betamethasone-acetate for fetal lung maturation in preterm sheep.American journal of obstetrics and gynecology · 2018Article
- Corticosteroids for preterm deliveries: missing evidence.The Cochrane database of systematic reviews · 2017Article
- Risk factors for possible serious bacterial infection in a rural cohort of young infants in central India.BMC public health · 2016Article
- 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.Reproductive health · 2016Article
- The neonatal gut microbiome and global health.Gut microbesReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
23 authors at 17 institutions in 7 countries.
Funding
Abstract
backgroundThe Antenatal Corticosteroid Trial assessed the feasibility, effectiveness, and safety of a multifaceted intervention to increase the use of antenatal corticosteroids (ACS) in mothers at risk of preterm birth at all levels of care in low and middle-income countries. The intervention effectively increased the use of ACS but was associated with an overall increase in neonatal deaths. We aimed to explore plausible pathways through which this intervention increased neonatal mortality.
methodsWe conducted a series of secondary analyses to assess whether ACS or other components of the multifaceted intervention that might have affected the quality of care contributed to the increased mortality observed: 1) we compared the proportion of neonatal deaths receiving ACS between the intervention and control groups; 2) we compared the antenatal and delivery care process in all births between groups; 3) we compared the rates of possible severe bacterial infection between groups; and 4) we compared the frequency of factors related to ACS administration or maternal high risk conditions at administration between the babies who died and those who survived 28 days among all births in the intervention group identified as high risk for preterm birth and received ACS.
resultsThe ACS exposure among the infants who died up to 28 days was 29 % in the intervention group compared to 6 % in controls. No substantial differences were observed in antenatal and delivery care process between groups. The risk of pSBI plus neonatal death was significantly increased in intervention clusters compared to controls (2.4 % vs. 2.0 %, adjusted RR 1.17, 95 % CI 1.04-1.30, p = 0.008], primarily for infants with birth weight at or above the 25(th) percentile. Regarding factors related to ACS administration, term infants who died were more likely to have mothers who received ACS within 7 days of delivery compared to those who survived 28 days (26.5 % vs 17.9 %, p = 0.014), and their mothers were more likely to have been identified as high risk for hypertension and less likely for signs of preterm labor.
conclusionsThese results suggest that ACS more than other components of the intervention may have contributed to the overall increased neonatal mortality. ACS may have also been involved in the observed increased risk of neonatal infection and death. Further trials are urgently needed to clarify the effectiveness and safety of ACS on neonatal health in low resource settings.
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