Intratracheal administration of budesonide with surfactant in very low birth weight infants to prevent bronchopulmonary dysplasia

Background and objectives. Respiratory distress syndrome (RDS) is a major cause of early postnatal death in preterm infants. Bronchopulmonary dysplasia (BPD) is one of the most fatal chronic respiratory complications of preterm infants after management of RDS. Anti-inflammatory therapy with corticosteroid is one of the effective treatments to prevent BPD. However, systemic administration of corticosteroid is not recommended because of long-term adverse effects. We studied the effect of early intratracheal instillation of budesonide with surfactant in preterm infants with severe RDS. Method. Very low birth weight infants (VLBWIs) weighing less than 1,500 g who were admitted to the neonatal intensive care unit (NICU) of Busan Paik Hospital between January 2018 and December 2018 and diagnosed with severe RDS were enrolled. The treatment group was given a mixture of budesonide and surfactant (calfactant) while the control group was given surfactant (calfactant) only. Results. Surfactant re-dosing, duration of mechanical ventilation, BPD, mortality, and retinopathy of prematurity (≥ stage 2) were not different between the two groups though there were decreasing trends in the treatment group compared to those in the control group. The duration of hospital stay was longer in the control group with statistical significance. Conclusion. Early intratracheal administration of budesonide with surfactant in preterm infants with severe RDS might decrease BPD and mortality without disturbing surfactant function. Further studies with different preparations of surfactants with a large number of preterm infants are required.

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1. Jobe AH. Mechanisms of lung injury and bronchopulmonary dysplasia. Am J Perinatol 2016; 33: 1076-1078.

2. Wilson-Costello D, Walsh MC, Langer JC, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Impact of postnatal corticosteroid use on neurodevelopment at 18 to 22 months' adjusted age: effects of dose, timing, and risk of bronchopulmonary dysplasia in extremely low birth weight infants. Pediatrics 2009; 123: e430-e437.

3. Watterberg KL; American Academy of Pediatrics. Committee on Fetus and Newborn. Policy statement--postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia. Pediatrics 2010; 126: 800-808.

4. Davidson LM, Berkelhamer SK. Bronchopulmonary dysplasia: chronic lung disease of infancy and longterm pulmonary outcomes. J Clin Med 2017; 6.

5. Committee on Fetus and Newborn. Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants. Pediatrics 2002; 109: 330- 338.

6. National Asthma Education and Prevention Program. Expert Panel Report: Guidelines for the diagnosis and management of asthma update on selected topics-2002. J Allergy Clin Immunol 2002; 110(Suppl 5): S141-S219.

7. Bassler D, Plavka R, Shinwell ES, et al; NEUROSIS Trial Group. Early inhaled budesonide for the prevention of bronchopulmonary dysplasia. N Engl J Med 2015; 373: 1497-1506.

8. Nakamura T, Yonemoto N, Nakayama M, et al; The Neonatal Research Network. Early inhaled steroid use in extremely low birthweight infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2016; 101: F552-F556.

9. Mazela J, Polin RA. Aerosol delivery to ventilated newborn infants: historical challenges and new directions. Eur J Pediatr 2011; 170: 433-444.

10. Ricci F, Catozzi C, Ravanetti F, et al. In vitro and in vivo characterization of poractant alfa supplemented with budesonide for safe and effective intratracheal administration. Pediatr Res 2017; 82: 1056-1063.

11. Agassandian M, Mallampalli RK. Surfactant phospholipid metabolism. Biochim Biophys Acta 2013; 1831: 612-625.

12. Parra E, Perez-Gil J. Composition, structure and mechanical properties define performance of pulmonary surfactant membranes and films. Chem Phys Lipids 2015; 185: 153-175.

13. Perez-Gil J, Weaver TE. Pulmonary surfactant pathophysiology: current models and open questions. Physiology (Bethesda) 2010; 25: 132-141.

14. van't Veen A, Gommers D, Mouton JW, Kluytmans JA, Krijt EJ, Lachmann B. Exogenous pulmonary surfactant as a drug delivering agent: influence of antibiotics on surfactant activity. Br J Pharmacol 1996; 118: 593-598.

15. van't Veen A, Mouton JW, Gommers D, Lachmann B. Pulmonary surfactant as vehicle for intratracheally instilled tobramycin in mice infected with Klebsiella pneumoniae. Br J Pharmacol 1996; 119: 1145-1148.

16. Kharasch VS, Sweeney TD, Fredberg J, et al. Pulmonary surfactant as a vehicle for intratracheal delivery of technetium sulfur colloid and pentamidine in hamster lungs. Am Rev Respir Dis 1991; 144: 909-913.

17. Pham S, Wiedmann TS. Note: dissolution of aerosol particles of budesonide in Survanta, a model lung surfactant. J Pharm Sci 2001; 90: 98-104.

18. Huang LT, Yeh TF, Kuo YL, Chen PC, Chen CM. Effect of surfactant and budesonide on the pulmonary distribution of fluorescent dye in mice. Pediatr Neonatol 2015; 56: 19-24.

19. Jobe AH. 50 Years ago in The Journal of Pediatrics: Respiratory distress syndrome of newborn infants: I. Diagnosis and incidence Miller H. J Pediatr 1962; 61: 2-8. Respiratory Distress Syndrome of Newborn Infants: II. Clinical Study of Pathogenesis Miller H. J Pediatr 1962; 61: 9-16. J Pediatr 2012; 161: 93.

20. Yeh TF, Lin HC, Chang CH, et al. Early intratracheal instillation of budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants: a pilot study. Pediatrics 2008; 121: e1310-e1318.

21. Kuo HT, Lin HC, Tsai CH, Chouc IC, Yeh TF. A follow-up study of preterm infants given budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants. J Pediatr 2010; 156: 537- 541.

22. Fenton TR. A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr 2003; 3: 13.

23. Kinsella JP, Greenough A, Abman SH. Bronchopulmonary dysplasia. Lancet 2006; 367: 1421-1431.

24. Stoll BJ, Hansen NI, Adams-Chapman I, et al; National Institute of Child Health and Human Development Neonatal Research Network Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004; 292: 2357-2365.

25. Miller-Larsson A, Mattsson H, Hjertberg E, Dahlback M, Tunek A, Brattsand R. Reversible fatty acid conjugation of budesonide. Novel mechanism for prolonged retention of topically applied steroid in airway tissue. Drug Metab Dispos 1998; 26: 623-630.

26. Tunek A, Sjodin K, Hallstrom G. Reversible formation of fatty acid esters of budesonide, an antiasthma glucocorticoid, in human lung and liver microsomes. Drug Metab Dispos 1997; 25: 1311-1317.

27. Shah SS, Ohlsson A, Halliday HL, Shah VS. Inhaled versus systemic corticosteroids for the treatment of chronic lung disease in ventilated very low birth weight preterm infants. Cochrane Database Syst Rev 2003: CD002057.

28. Shah SS, Ohlsson A, Halliday HL, Shah VS. Inhaled versus systemic corticosteroids for the treatment of chronic lung disease in ventilated very low birth weight preterm infants. Cochrane Database Syst Rev 2007: CD002057.

29. Shah SS, Ohlsson A, Halliday HL, Shah VS. Inhaled versus systemic corticosteroids for the treatment of chronic lung disease in ventilated very low birth weight preterm infants. Cochrane Database Syst Rev 2012: CD002057.

30. Fajardo C, Levin D, Garcia M, Abrams D, Adamson I. Surfactant versus saline as a vehicle for corticosteroid delivery to the lungs of ventilated rabbits. Pediatr Res 1998; 43(4 Pt 1): 542-547.

31. Chen CM, Fang CL, Chang CH. Surfactant and corticosteroid effects on lung function in a rat model of acute lung injury. Crit Care Med 2001; 29: 2169- 2175.

32. Nimmo AJ, Carstairs JR, Patole SK, Whitehall J, Davidson K, Vink R. Intratracheal administration of glucocorticoids using surfactant as a vehicle. Clin Exp Pharmacol Physiol 2002; 29: 661-665.

33. Yang CF, Jeng MJ, Soong WJ, Lee YS, Tsao PC, Tang RB. Acute pathophysiological effects of intratracheal instillation of budesonide and exogenous surfactant in a neonatal surfactant-depleted piglet model. Pediatr Neonatol 2010; 51: 219-226.

34. Yang CF, Lin CH, Chiou SY, et al. Intratracheal budesonide supplementation in addition to surfactant improves pulmonary outcome in surfactant-depleted newborn piglets. Pediatr Pulmonol 2013; 48: 151-159.

35. Roberts JK, Stockmann C, Dahl MJ, et al. Pharmacokinetics of budesonide administered with surfactant in premature lambs: implications for Neonatal Clinical Trials. Curr Clin Pharmacol 2016; 11: 53-61.

36. Yeh TF, Chen CM, Wu SY, et al. Intratracheal administration of budesonide/surfactant to prevent bronchopulmonary dysplasia. Am J Respir Crit Care Med 2016; 193: 86-95.
Turkish Journal of Pediatrics-Cover
  • ISSN: 0041-4301
  • Yayın Aralığı: Yılda 6 Sayı
  • Başlangıç: 1958
  • Yayıncı: Hacettepe Üniversitesi Çocuk Sağlığı Enstitüsü Müdürlüğü
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