Inhaled corticosteroids in ventilated preterm neonates: a non-randomized dose-ranging study – BMC Pediatrics

 

Abstract

Background

Inhaled corticosteroids (ICS) offer targeted treatment for bronchopulmonary dysplasia (BPD) with minimal systemic effects compared to systemic steroids. However, dosing of ICS in the management of infants at high-risk of developing BPD is not well established. The objective of this study was to determine an effective dose of ICS for the treatment of ventilator-dependent infants to facilitate extubation or reduce fractional inspired oxygen concentration.

Methods

Forty-one infants born at < 32 weeks gestational age (GA) or < 1250 g who were ventilator-dependent at 10–28 days postnatal age were included. A non-randomized dose-ranging trial was performed using aerosolized inhaled beclomethasone with hydrofluoralkane propellant (HFA-BDP). Four dosing groups (200, 400, 600 and 800 μg twice daily for 1 week) with 11, 11, 10 and 9 infants in each group, respectively, were studied. The primary outcome was therapeutic efficacy (successful extubation or reduction in FiO₂ of > 75% from baseline) in ≥60% of infants in the group. Oxygen requirements, complications and long-term neurodevelopmental outcomes were also assessed.

Results

The median age at enrollment was 22 (10–28) postnatal days. The primary outcome, therapeutic efficacy as defined above, was not achieved in any group. However, there was a significant reduction in post-treatment FiO₂ at a dose of 800 μg bid. No obvious trends were seen in long-term neurodevelopmental outcomes.

Conclusions

Therapeutic efficacy was not achieved with all studied doses of ICS. A significant reduction in oxygen requirements was noted in ventilator-dependent preterm infants at 10–28 days of age when given 800 μg of HFA-BDP bid. Larger randomized trials of ICS are required to determine efficacy for the management of infants at high-risk for development of BPD.

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NIHR Signal: Corticosteroids given early reduce risk of heart problems in children with Kawasaki disease

Published on 14 February 2017

Early treatment with corticosteroids on top of standard therapy reduces the risk of serious heart problems in children under five with the rare vascular disease, Kawasaki disease.

The disease needs to be recognised early, but can be hard to spot outside specialist care because it is so rare. It is now the commonest cause of acquired heart disease in children and delayed diagnosis can have serious consequences. Blood vessels supplying the heart become inflamed, increasing the risk of heart attack and death in later life. The disease is about 20 times more common in people of Japanese origin.

This summary of the evidence found that adding corticosteroids early to standard treatment within five days of onset of symptoms reduced the risk of serious abnormalities in the heart arteries by more than two thirds.

Corticosteroids were not effective when used as rescue treatment after standard treatment had failed.

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