COMPARATIVE EFFECTIVENESS OF DEXAMETHASONE INJECTION PER 12 HOURS

AND 24 HOURS FOR NEONATES OUTPUT AT THREAT OF PRETERM LABOR

Abstract
Objective: To compare effectiveness of dexamethasone injection per 12 hours and per 24 hours
for fetal lung maturation.
Methods: This study is a single-blind randomized clinical trials in pregnant women with preterm
labor threat (age 28 to 34 weeks). A total of 60 subjects were included in the study were divided
randomly into groups dexamethasonper 12 hours (n = 30) and group dexamethason per 24 hours
(n = 30). There are 6 subjects dropped out in each group that also performed analysis. Lung
maturity assessment conducted with Tapp test events and respiratory distress (GN) assessed at
birth.
Results: Of the 60 research subjects only 29 subjects that can be tested Tap. In the
dexamethasone group per 12 hours earned 15 subjects (100%) with mature lung and
dexamethasone groups per 24 hours were 13 subjects (92.8%) with mature lung. Most of the
research subjects in both groups showed Tap test positive (mature lungs). Comparison of test
results obtained Tap between groups was not significant (p = 0.187). Most babies are born not
experiencing respiratory distress (GN) notes that as many as 35 infants (58.3%), consisting of 18
infants (60%) in the dexamethasone group per 12 hours and 17 infants (57%) in the
dexamethasone group per 24 hours. GN comparisons between the study group was found no
significant (p = 0.156).
Conclusion: Dexamethasone per 12 hours per 24-hour and dexamethasone as effective as fetal
lung maturation in women with preterm labor threat

Keywords: dexamethason, lung maturation, respiratory distress

INTRODUCTION

Provision of glucocorticoids to accelerate fetal lung development in patients who are at risk of
preterm birth is one of the pillars of the current in neonatal care and obstetrics. Provision of
glucocorticoids during pregnancy has benefits in reducing the incidence of respiratory distress
syndrome (SGN) in infants born at 24-34 weeks gestation. Two types of glucocorticoids are the
most widely used for lung maturation is betamethasone and dexamethasone. Treatment regimen
recommended by the National Institutes of Health (NIH) is the maternal dose is 2 doses of
intramuscular betamethasone 12 mg per 24 hours apart or four doses of 6 mg dexamethasone
intramuscularly per 12 hours separately. Most maternity units in the UK give betamethasone or
dexamethasone in two doses per 24 hours separately ie 2 x 12 mg.
The total dose of 24 mg is based on animal studies and then show a fetus is able to achieve a
concentration comparable to the normal physiological stress levels of cortisol that occurs after
birth. Giving the total dose compared to administration intervals provide maximum benefit to the
fetus. This is supported by data from the National Institutes of Health and Human Development
Neonatal Research Network, says that> 2 doses of corticosteroids are more effective compared to
the treatment of partial (<2). However, approximately 25-45% of pregnant women with the risk
of preterm labor giving birth within 24 hours, after receiving corticosteroid therapy is complete.
Only about 5% who gave birth within 12 hours. Prospective randomized trials have used doses
varying intervals (8, 12, or 24 hours) for the provision of a total dose of 24 mg of long-acting
corticosteroid (betamethasone or dexamethasone). In fact, a meta-analysis of these studies
emphasize the dosing interval and the total over, "policy corticosteroids (betamethasone 24 mg,
24 mg dexamethasone or hydrocortisone 2 g) for women at risk of preterm labor is expected to
reduce mortality and neonatal morbidity. Never found the side effects of this policy ". Because
preterm labor is the cause of mortality and morbidity are high enough so that the fetus is very
useful to ascertain whether different dexamethasone regimen (per 12 hours or per 24 hours) gives
the same effect in preventing SGN on neonatus.

METHODS
This study is a single-blind randomized clinical trials in pregnant women with preterm labor
threat, gestational age of 28 to 34 weeks in the Department of Obstetrics and Gynecology
Hospital, MOH Hoesin Palembang. The study was conducted from January 2014 to January
2015. Criteria for admission is 28-34 weeks gestation who proved of ultrasound in women threat
of preterm parturition and gave birth at less than 35 weeks gestational age. The number of
samples that meet the acceptance criteria of 60 subjects, divided randomly into two groups: 30
subjects included in the dexamethasone group per 12 hours and 30 subjects in the dexamethasone
group per 24 hours. There are 6 subjects dropped out in each group also performed the analysis.
Lung maturity assessment conducted by Tapp test. Limit values for lung maturation at random is
5 foam. If no more than 5 layers of foam on the ether, the test is considered mature lung.
Incidence of respiratory distress (GN), which is characterized by symptoms of tachypnea,
cyanosis, ribs and sternum retraction and moaning during expiration assessed at the time of the
newborn by a medical expert child health department of pediatrics section MOH Hoesin
palembang where the assessor did not know which treatment the samples obtained .

RESULTS
Distribution of age of subjects in both treatment groups were mostly in the age group 20-35
years, with a high school education, occupation housewife who put in a group does not work,
parity> 2 and gestational age 30-33 weeks. From the statistical analysis using the chi-square
there is no significant difference on the general characteristics of the two groups of subjects.
Of the 60 research subjects only 29 subjects that can be tested Tap. Most of the research subjects
in both groups showed Tap test positive (mature lungs). In the dexamethasone group per 12
hours earned 15 subjects (100%) with mature lung and dexamethasone groups per 24 hours were
13 subjects (92.8%) with mature lung. Comparison of test results obtained Tap between groups
was not significant (p = 0.187). Most babies are born not experience notes that as many as 35

infants (58.3%), consisting of 18 infants (60%) in the dexamethasone group per 12 hours and 17
infants (57%) in the dexamethasone group per 24 hours. GN incidence was found in 12 infants
(40%) of the group dexamethason per 12 hours and in 13 infants (43%) of the group
dexamethason per 24 hours. GN comparisons between the study group found no significant (p =
0.156). Based infants with GN obtained largely HMD baby does not have as many as 15 infants
(60%), consists of 8 infants (67%) in the dexamethasone group per 12 hours and 7 infants (54%)
in the dexamethasone group per 24 hours. HMD comparisons between groups were analyzed
using the Kruskal-Wallis and found no significant (p = 0.809).

DISCUSSION
In the study presented here, there are 6 subjects drop put in each group due to childbirth before
the completion of drug intervention. All subjects dropped out in this study also analyzed to see
whether there are differences Tap trials, the incidence of HMD RD (respiratory distress) and
events between subjects who received the complete and incomplete cycle. The number of
subjects that can be tested Tap from all groups, a total of 29 subjects with 15 subjects in the
dexamethasone group per 12 hours and 14 subjects in the dexamethasone group per 24 hours.
Tap Test in the dexamethasone group per 12 hour cycle is complete and incomplete obtained the
whole subject with mature Tap test results, whereas in the dexamethasone group per 24 hours is
obtained only one subject with Tap test results are not mature from an incomplete cycle. The
difference in test results obtained Tap in all groups was not statistically significant with p =
0.187. It shows that dexamethasone and dexamethasone per 12 hours per 24-hour either
complete or incomplete cycle as effective as fetal lung maturation in women with preterm labor
threat. Research by Bajracharya in 2012 in Nepal Tap test on amniotic fluid 91 preterm infants
born without SGN obtained 82 test results Tap Mature (indicates Tap test specificity 90.1%) and
in 17 immature Tap test was only 8 infants with SGN (shows the predictive value of 47.1%).
Most of the research subjects in all groups did not experience the notes that 18 subjects in the
dexamethasone group per 12 hours and 17 subjects in the dexamethasone group per 24 hours.
GN differences between all groups research found no statistically significant with p = 0.156.
These results indicate that there is no difference between the dexamethasone group GN events
per 12-hour and 24-hour dexamethasone per cycle both complete and incomplete. Based on

observational studies, there are a total of 25 subjects (41.7%) experienced GN, consisting of 12
subjects in the dexamethasone group per 12 hours which 4 subjects with positive HMD assessed
from radiographs of infants and 13 subjects in the dexamethasone group per 24 hours with 5
positive HMD subject of X-ray picture of a baby. HMD comparisons between groups were
analyzed using the Kruskal-Wallis and p value = 0.809. These results indicate that there is no
difference between the incidence of HMD dexamethasone group and dexamethasone per 12
hours per 24-hour cycle either complete or incomplete. In some publications, among others, one
RCT study by Helji et al in 2009 and one observational study by Behrooz et al in 2010 showed
the effectiveness of dexamethasone decreased the incidence of respiratory distress syndrome by
49% and 23%. In six other RCT studies showed antenatal dexamethasone administration showed
a decrease in neonatal mortality rate of 28% and a decrease in the incidence of respiratory
distress syndrome by 20% compared with placebo or no treatment. Also there is evidence that
lung maturation with betamethasone or dexamethasone incomplete also provide some benefits in
terms of reducing morbidity for baby.

CONCLUSION
Dexamethasone per 12 hours per 24-hour and dexamethasone as effective as fetal lung
maturation in women with preterm labor threat.

ADVICE
Administering dexamethasone at a dose of 24 mg of either maternal administration per 12 hours
or per 24 hours can be recommended as fetal lung maturation in women with preterm labor
threat.