Corticosteroids safe and effective for preventing preterm newborn death and respiratory complications in low and middle-income countries

The WHO ACTION-I Trial was a multi-country efficacy trial of antenatal dexamethasone for women at risk of imminent preterm birth in low-resource countries. The trial randomised 2,852 women and their 3070 babies at 29 hospitals In Bangladesh, India, Kenya, Nigeria and Pakistan. Importantly, the trial was conducted in hospitals that were capable of providing comprehensive obstetric care, and a minimal package of care for preterm newborns.

The trial demonstrated that administration of dexamethasone to women who were at risk for early preterm birth reduced the incidence of neonatal death, without increasing the incidence of maternal bacterial infection. This has resolved the ongoing controversy about the efficacy of antenatal steroids in early preterm birth in low-resource countries.