Pregnancy drug 'held back'

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The Independent Online
A CHEAP and effective drug treatment that reduces the death rate among premature babies is being withheld from pregnant women by some doctors, despite strong scientific evidence to support its widespread use.

A survey of more than 300 premature births found that only one-fifth of women who would benefit from antenatal treatment with steroid drugs was offered it. Giving steroids to women at high risk of premature birth can reduce breathing problems in their babies by up to 60 per cent.

The survey reinforces recent criticisms of some obstetricians by Dr Iain Chalmers, former director of the National Perinatal Epidemiology Unit at Radcliffe Infirmary, Oxford. He accused them of 'shroud-waving' to promote practices which were unsupported by research, while withholding forms of care - such as antenatal steroid treatment - known to reduce mortality in the newborn.

Each year 60,000 babies are born too soon and premature delivery is the largest single cause of death in the first few weeks. This is usually linked to breathing problems because the babies' lungs are immature and lack the chemical, surfactant, which helps the lungs inflate.

A large dose of steroids before birth appears to 'kick-start' the production of surfactant. Alternative treatments for premature babies, such as artificial respiratory support, are expensive and risk infection.

Dr Edmund Hey, a consultant paediatrician at the Princess Mary Maternity Hospital, Newcastle upon Tyne, said yesterday that he was alarmed by the failure of doctors to use a proved treatment supported by at least 12 clinical studies over the last 20 years.

The survey, carried out for the Northern Regional Health Authority, was representative of the national picture, he added. Since the results of the survey became known, antenatal steroid use in the region had doubled.

Dr Rita Khanna, from the Princess Mary Maternity Hospital, and Dr Sam Richmond, a consultant paediatrician at The Royal Infirmary, Sunderland, reviewed the notes of all babies born more than eight weeks early in the Northern region between 1990 and 1991.

They concluded that: 'Given the cost effectiveness of this approach (steroid treatment) when compared to other approaches . . . the reluctance with which this is adopted does call for some explanation.'