EFFICACY OF TWO REGIMENS OF DEXAMETHASONE FOR MANAGEMENT OF PRETERM LABOUR: PILOT STUDY
Abstract
Background: Dexamethasone is widely used for prevention of respiratory distress syndrome (RDS), necrotising enterocolitis (NEC) and intra-ventricular haemorrhage (IVH) in preterm babies; decreasing the neonatal mortality rate. There is no consensus on the dose of corticosteroid administered to the mother expected to have a preterm baby. This study is conducted to compare the effectiveness of two popular regimens of dexamethasone administration in decreasing incidence of RDS, necrotizing enterocolitis, IVH and neonatal mortality rate. Methods: Randomized control trial was conducted at Ayub Teaching Hospital, Abbottabad from 1st to 31st August, 2014. Sample size was set at 50. Block randomization was employed in the trial to allocate the patients into corresponding groups ‘A’ and ‘B’. Group A was administered 6mg dexamethasone in 4 doses 12 hours apart and group B was administered 2 doses 12 hours apart. Results: Forty-eight patients participated in the study with 24 patients in each group. Mean age and period gestation of participants were 28.4 years±4.3 SD and 34 weeks±1.9 SD respectively. Four patients in group A gave birth to neonate with RDS compared to two cases in group B. Group B had higher incidence of necrotizing enterocolitis and neonatal mortalities. However, none of these differences observed were statistically significant. No case of IVH was reported in either of the groups. Conclusion: Both the popular regimens of dexamethasone administration are equally effective in decreasing the incidence of neonatal diseases.Keywords: dexamethasone; preterm babies; respiratory distress syndrome; necrotizing enterocolitis; intra-ventricular haemorrhageReferences
WHO. The Selection and Use of Essential Medicines: Report of the WHO Expert Committee, 2013 (including the 18th WHO Model List of Essential Medicines and the 4th WHO Model List of Essential Medicines for Children). Vol. 985. World Health Organization; 2014.
Garite TJ, Kurtzman J. A Randomized Double-Blinded Study Comparing the Impact of One versus Two Doses of Antenatal Steroids on Neonatal Outcome. [Internet]. [cited 2017 Jan 6]. Available from: https://www.pediatrix.com/blank.cfm?print=yes&id=259
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin.Assessment of risk factors for preterm birth.Clinical management guidelines for obstetrician-gynecologists. Number 31, October 2001. (Replaces Technical Bulletin number 206, June 1995; Committee Opinion number 172, May 1996; Committee Opinion number 187, September 1997; Committee Opinion number 198, February 1998; and Committee Opinion number 251, January 2001). Obstet Gynecol 2001;98(4):709–16.
Roberts D, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006;(3):CD004454.
Roubliova XI, Van der Biest AM, Vaast P, Lu H, Jani J, Lewi PJ, et al. Effect of maternal administration of betamethasone on peripheral arterial development in fetal rabbit lungs. Neonatology 2008;93(1):64–72.
Kari MA, Hallman M, Eronen M, Teramo K, Virtanen M, Koivisto M, et al. Prenatal dexamethasone treatment in conjunction with rescue therapy of human surfactant: a randomized placebo-controlled multicenter study. Pediatrics 1994;93(5):730–6.
Higgins RD, Mendelsohn AL, DeFeo MJ, Ucsel R, Hendricks-Munoz KD. Antenatal dexamethasone and decreased severity of retinopathy of prematurity. Arch Ophthalmol 1998;116(5):601–5.
Cummings JJ, D'Eugenio DB, Gross SJ. A controlled trial of dexamethasone in preterm infants at high risk for bronchopulmonary dysplasia. New Engl J Med 1989;320(23):1505–10.
Royal College of Obstetricians and Gynaecologists. Antenatal corticosteroid to reduce neonatal mortality and morbidity, volume 7, Oct 2010, RCOG green-top guideline no7, page no 2. [Internet]. [cited 2017 Jan 6]. Available from: https://www.glowm.com/pdf/Antenatal%20Corticosteroids%20to%20Reduce%20Neonatal%20Morbidity.pdf
19th expert committee on the selection and use of essential medicines. [Internet]. [cited 2017 Jan 6]. Available from: http://www.who.int/selection_medicines/committees/expert/19/applications/Dexamethasone_29_C_NI.pdf
Guideline on the use of Antenatal Corticosteroids to Prevent Respiratory Distress Syndrome. [Internet]. [cited 2017 Jan 6]. Available from: file:///C:/Users/Wali%20Muhammad/Downloads/Guideline%20on%20the%20use%20of%20Antenatal%20steroids%20-revised.pdf
Magee LA, Dawes GS, Moulden M, Redman CW. A randomised control comparison of betamethasone with dexamethasone: effects on the antenatal fetal heart rate.’ Br J Obstet Gynaecol 1997;104(11):1233–8.
Kamath BD, Macguire ER, McClure EM, Goldenberg RL, Jobe AH. Neonatal mortality from respiratory distress syndrome: lessons for low-resource countries. Pediatrics 2011;127(6):1139–46.
Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: final data for 2002. Natl Vital Stat Rep 2003;52(10):1–113.
Jobe AH, Soll RF. Choice and dose of corticosteroid for antenatal treatments. Am J Obstet Gynecol 2004;190(4):878–81.
Brownfoot FC, Crowther CA, Middleton P. Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2008;(4):CD006764.
Crowther CA, Haslam RR, Hiller JE, Doyle LW, Robinson JS. Neonatal respiratory distress syndrome after repeat exposure to antenatal corticosteroids: a randomised controlled trial. Lancet 2006;367(9526):1913–9.
Peaceman AM, Bajaj K, Kumar P, Grobman WA. The interval between a single course of antenatal steroids and delivery and its association with neonatal outcomes. Am J Obstet Gynecol 2005:193(3 Pt 2):1165–9.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.