Inhaled versus systemic steroids in chronic oxygen dependency  of preterm infants

Dimitriou, Gabriel; Greenough, A; Giffin, F.; Kavadia, V

doi:10.1007/s004310050552

Cited by 44 publications

(28 citation statements)

References 16 publications

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“…Those results are in keeping with the findings of a randomised trial which included non ventilated infants [24]; systemic steroids were demonstrated to have a more rapid and greater magnitude of effect than inhaled steroids. In addition, in another study [25] a three day course of systemic steroids was more effective than a ten day course of inhaled steroids in reducing the inspired oxygen requirement and levels of inflammatory mediators.…”

Section: (B) Inhaled Versus Systemic Treatmentsupporting

confidence: 82%

Corticosteroids in infant chronic lung disease

May

Greenough

2004

Monaldi Arch Chest Dis

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Chronic lung disease (CLD), defined as chronic oxygen dependency at 36 weeks postmenstrual age, is increasing and associated with chronic respiratory morbidity and high health care utilisation at follow up. Many strategies, tested in randomised trials, have failed to reduce CLD. In contrast, corticosteroids if given systemically within the first two weeks after birth reduce CLD and may also favourably influence survival. Unfortunately, systemically administered corticosteroids have many acute side-effects and adversely affect long term neurodevelopmental outcome. If given by inhalation, corticosteroids have fewer adverse effects, but are less efficacious. Further research is required to accurately identify infants at highest risk of developing CLD, the corticosteroid dosage associated with a positive risk: benefit ratio and preferably a safer and more effective alternative therapy.

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Section: (B) Inhaled Versus Systemic Treatmentsupporting

confidence: 82%

Corticosteroids in infant chronic lung disease

May

Greenough

2004

Monaldi Arch Chest Dis

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“…Dimitriou et al 15 studied 40 preterm infants who had remained either ventilator-or supplemental-oxygen-dependent with no improvement in their respiratory status in a prospective randomized trial. Beginning at a postnatal age of 26 to 27 days, the premature infants were randomized to either 100 g/d inhaled budesonide or intravenous dexamethasone for 10 days.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Trial of Inhaled Versus Intravenous Steroids in Ventilator-Dependent Preterm Infants

Suchomski

Cummings

2002

J Perinatol

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“…For inhaled steroids the trials were categorised as: (1) early (! 7 days) [37][38][39][40][41][42][43]; (2) late (614 days) [44][45][46][47], or (3) inhaled versus systemic [48][49][50]. In addition, there was one trial which compared 3 days of systemic dexamethasone followed by 18 days of inhaled budesonide with placebo [27].…”

Section: Methodsmentioning

confidence: 99%

“…Three randomized trials compared inhaled and systemic steroids [48][49][50]. The inhaled steroids used were beclomethasone [48,49] and budesonide [50] (table 3).…”

Section: Inhaled Versus Systemic Steroidsmentioning

confidence: 99%

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Clinical Trials of Postnatal Corticosteroids: Inhaled and Systemic

Halliday¹

1999

Neonatology

100

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Chronic lung disease (CLD) remains a common problem in neonatal intensive care units. Corticosteroids are being used increasingly to prevent or treat CLD. Uncertainties remain including the timing, duration and route of administration, and ratio of benefits to costs. This paper reviews the outcome of 39 randomized clinical trials of postnatal corticosteroid treatment. Twenty-five trials studied systemic steroids at three different postnatal ages; early (<96 h), moderately early (7–14 days), and delayed (>3 weeks). Fourteen-trials studied inhaled steroids (early: <7 days; late: >14 days) and inhaled versus systemic steroids. Systemic steroids have short-term beneficial effects improving gas exchange and lung mechanics to facilitate earlier extubation when used at any postnatal age in infants who are ventilator dependent. Early and moderately early steroids also reduce the risk of CLD at both 28 days and 36 weeks. For moderately early steroid use, there is also a reduction in neonatal mortality with 1 extra survivor for approximately every 16 babies treated (95% confidence interval 9–55). Proven adverse effects are either gastro-intestinal (bleeding) or metabolic (hyperglycaemia and hypertension). Unproven but potential adverse effects include decreased brain and lung growth. Inhaled steroids have been studied less thoroughly. Some studies report improvement in gas exchange and lung mechanics, but long-term benefits are not apparent to date in the published material. Trials comparing inhaled and systemic steroids suggest a more rapid response with the latter, but no significant differences in the rate of CLD at either 28 days or 36 weeks were found. Further research is necessary to define the roles of systemic and inhaled steroids in the prevention and treatment of CLD and to allow comparison of benefits to costs.

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Inhaled versus systemic steroids in chronic oxygen dependency of preterm infants

Abstract: Systemically administered rather than inhaled steroids appear to have a faster onset of action.

Cited by 44 publications

References 16 publications

Corticosteroids in infant chronic lung disease

Corticosteroids in infant chronic lung disease

A Randomized Trial of Inhaled Versus Intravenous Steroids in Ventilator-Dependent Preterm Infants

Clinical Trials of Postnatal Corticosteroids: Inhaled and Systemic

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