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

Abstract

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.

Keywords: bronchopulmonary dysplasia; budesonide; preterm infant; pulmonary surfactant; respiratory distress syndrome.