Early Inhaled Glucocorticoid Therapy to Prevent Bronchopulmonary Dysplasia

Abstract

Early beclomethasone therapy did not prevent bronchopulmonary dysplasia but was associated with lower rates of use of systemic glucocorticoid therapy and mechanical ventilation.

Effects of early inhaled beclomethasone therapy on tracheal aspirate inflammatory mediators IL-8 and IL-1ra in ventilated preterm infants at risk for bronchopulmonary dysplasia

“…As previously reported, 18 we noted no difference in tracheal colonization or systemic infection between groups on any of the tracheal aspirate sampling days.…”

“…18 The daily dose of beclomethasone dipropionate was tapered during 4 weeks from 1,000 to 125 g/ kg/day emitted from the metering valve. This is equivalent to a delivered dose of 40 to 5 g/kg/day based on measurement of the dose exiting the endotracheal tube (4% of actuation dose).…”

“…14,17 Our group has shown that early inhaled beclomethasone therapy in preterm infants at risk for BPD is associated with significantly less subsequent use of systemic glucocorticoid, less bronchodilator therapy, and less mechanical ventilation at 28 days of age, but that it does not prevent BPD. 18 In this study, we tested the hypothesis that early inhaled beclomethasone therapy reduces pulmonary inflammation in ventilated preterm infants at increased risk for BPD. We chose to measure interleukin-8 (IL-8) because this is one of the most potent and abundant neutrophil chemoattractant cytokines present in the lungs.…”

Post-natal corticosteroid use

“…Inhaled compared to systemic administration of corticosteroids have a slower onset of action and smaller magnitude of effect [6,12]. In a large randomised trial assessing the efficacy of inhaled corticosteroids, care was taken to maximise corticosteroid delivery, but the only positive effects noted were that fewer infants who had received inhaled beclomethasone subsequently received systemic glucocorticoid therapy, fewer infants were on mechanical ventilation at 28 days and fewer infants required bronchodilator therapy [4]. The limited efficacy of early administration of inhaled corticosteroids demonstrated so far is the likely explanation for the low numbers prescribing that therapy.…”

Inflammatory Mediators in the Immunobiology of Bronchopulmonary Dysplasia

“…Clinical Benefits and Adverse Effects of Corticosteroid Use in Preterm Infants at Risk of BPD Corticosteroid therapy, specifically dexamethasone, reduces inflammation and reduces the duration of oxygen dependence and incidence of BPD but has adverse effects on growth and development [187][188][189]. The American Academy of Pediatrics and the Canadian Pediatric Society issued a joint statement in 2002 regarding the postnatal use of corticosteroids for the prevention or treatment of BPD [190].…”