Short-term Effects of Inhaled Corticosteroid Following Early Systemic Corticosteroid Administration in Premature Babies with Respiratory Distress Syndrome: A Preliminary Report

ABSTRACT

PURPOSE: To asses the short-term effects of the topical corticosteroid, budesonide administered by metered dose inhaler(MDI) and spacer(Aerochamber MV 15) following systemic corticosteroid in premature babies with respiratory distress syndrome at birth. METHODS: 19 premature babies <1800gm were randomly assigned to receive steroids(n=9) or not (n=10). The steroid group(n=9, GA[gestational age]=29.6+/-2.9 weeks, BW[birth weight]=1.29+/-0.35kg) received systemic dexamethasone for 48 hours since 12-24 hours after birth, followed by inhaled budesonide, 2 puffs per dose(400mcg of total dose), administered three times a day until extubation. The control group(n=10, GA=29.9+/-2.5 weeks, BW=1.32+/-0.26kg) did not receive steroids. The parameters of ventilator and arterial blood gases were recorded every 6 hours during the first 8 days of age, and the ventilatorty efficiency index(VEI) and the arterial/Alveolar Oz(a/A Op) ratios were calculated before administration, on the 4th and 8th days of age respectively. RESULTS: The steroid-treated group showed significant improvements in mean peak inspiratory pressure, fraction of inspired oxygen, VEI and a/A % ratio on the 4th and 8th day of age. There were no changes in the control group. The steroid-treated group tended to show a lower incidence of PDA and a lower need for systernic corticosteroids without significant differences, compared with those in the control group. CONCLUSION: Sequential early systemic corticosteroid adrninistration started within 24 hours of age, followed by inhhaled budesonide given by MDI and spacer(MDIS) was associated with clinical improvements in respiratory status and ventilator support in premature babies with respiratory distress syndrome.