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Growth effects of systemic versus inhaled steroids in chronic lung disease
R M Nicholl1, A Greenough, M King
1Children Nationwide Regional Neonatal Intensive Care Centre, King's College Hospital, London, UK. drnicholl@aol.com
Insights
Inhaled budesonide demonstrated fewer short-term growth impacts than systemic dexamethasone in very low birthweight (VLBW) infants with chronic lung disease (CLD). This study compared inhaled budesonide and systemic dexamethasone effects on infant growth.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Pharmacology
Background:
- Chronic lung disease (CLD) is a common complication in very low birthweight (VLBW) infants.
- Systemic corticosteroids are often used to manage CLD but can impair growth.
- Alternative delivery methods and agents are being investigated to mitigate side effects.
Purpose of the Study:
- To compare the effects of inhaled budesonide versus systemic dexamethasone on linear growth in VLBW infants with CLD.
- To evaluate the short-term impact of different corticosteroid administration routes on infant growth parameters.
Main Methods:
- A randomized study involving 16 VLBW infants diagnosed with CLD.
- Treatment groups received either inhaled budesonide (100 microg four times daily for 10 days) or systemic dexamethasone (0.5 mg/kg/day, tapering over nine days).
- Linear growth, specifically lower leg length (LLL), was measured twice weekly using knemometry.
Main Results:
- Both treatment groups had similar baseline characteristics including gestational age, birth weight, and initial LLL velocity (LLLvel).
- LLLvel decreased in the dexamethasone group (mean -0.01 mm/day) but increased in the budesonide group (mean 0.48 mm/day) by the end of treatment.
- Mean weight gain was lower in the dexamethasone group (5.8 g/kg/day) compared to the budesonide group (12.7 g/kg/day), though this difference was not statistically significant.
Conclusions:
- Inhaled budesonide exhibits less detrimental short-term effects on infant growth compared to systemically administered dexamethasone.
- Inhaled corticosteroids may represent a safer alternative for managing CLD in VLBW infants regarding growth.
- Further research is warranted to confirm long-term growth outcomes and efficacy.
Aim:
To compare the effects of inhaled and systemic steroids on growth in very low birthweight (VLBW) infants with chronic lung disease (CLD).
Methods:
Sixteen babies with CLD randomly received inhaled budesonide (100 microg four times daily for 10 days via Aerochamber) or systemic steroids (dexamethasone 0.5 mg/kg/day, reducing over nine days). Linear growth (lower leg length, LLL) was measured by knemometry twice weekly.
Results:
The gestational age, birth weight, postnatal age, and LLL velocity (LLLvel) were similar between the two groups at the start of treatment. At the end of the treatment period, LLLvel was reduced in the dexamethasone group (mean -0.01 mm/day) but had increased in the budesonide group (mean 0.48 mm/day). Mean weight gain was non-significantly lower in the dexamethasone group (5.8 g/kg/day) compared to the budesonide group (mean 12.7 g/kg/day).
Conclusion:
Inhaled budesonide has less short term effects on growth than systemically administered dexamethasone.