Randomised controlled study of early use of inhaled corticosteroid in preterm infants with respiratory distress syndrome
a Department of
Paediatrics Prince of Wales Hospital
The Chinese University of Hong Kong
ShatinHong Kong
People's Republic of China, b Department of Medicine
McMaster University Medical Centre
Hamilton Ontario
Canada
Correspondence to: Dr T F Fok Email:taifaifok{at}cuhk.edu.hktaifaifok{at}cuhk.edu.hk
Accepted 26 October
1998
AIM
To investigate the
therapeutic efficacy of inhaled fluticasone propionate, started on day
1 of age, on ventilated preterm infants with respiratory distress syndrome.
METHODS
Starting
within 24 hours of age, ventilated preterm infants (gestation < 32 weeks, birthweight < 1.5 kg) with respiratory distress syndrome were
given a 14 day course (two puffs, 12 hourly) of either fluticasone
propionate (250 µg/puff) (group 1, n=27) or placebo (group 2, n=26)
with a metered dose inhaler-spacer device. Response to treatment was
assessed by the rate of successful extubation by days 7 and 14 of age,
changes in respiratory system mechanics, death, occurrence of chronic
lung disease, and other neonatal complications.
RESULTS
More infants
in the treatment group were successfully extubated by 14 days of age
than those in the placebo group (17/27 vs 8/26; p = 0.038). The treated infants also showed a more significant improvement in respiratory system compliance during the first 14 days
of life. The two groups, however, did not differ significantly in their
need for systemic steroids after day 14 of age, death, or the
occurrence of chronic lung disease. The treatment was not associated
with any increase in neonatal complications, including those
attributable to steroid induced side effects.
CONCLUSION
These
results provide preliminary evidence that early treatment with inhaled
corticosteroids may be beneficial to ventilated preterm infants with
respiratory distress. Further study of its use in a large scale
randomised trial is warranted.
Keywords: respiratory distress syndrome; mechanical ventilation; corticosteroid; aerosol; fluticasone propionate
© 1999 by Archives of Disease in Childhood
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