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Randomised trial of inhaled steroids in preterm infants with respiratory symptoms at follow up
1Department of Child Health, King's College Hospital, London.
Insights
Inhaled beclomethasone dipropionate significantly reduced respiratory symptoms and bronchodilator use in preterm infants. This treatment improved lung function, offering a useful option for managing wheezing and cough in this vulnerable population.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Pharmacology
Background:
- Preterm infants frequently experience recurrent respiratory symptoms post-discharge.
- Bronchodilator responsiveness varies, with some infants continuing to wheeze or cough despite treatment.
- Inhaled corticosteroids are being investigated for their efficacy in this population.
Purpose of the Study:
- To assess the effectiveness of inhaled steroids in reducing respiratory symptoms.
- To determine if inhaled steroids decrease the need for bronchodilator treatment.
- To evaluate the impact of inhaled steroids on lung function in preterm infants.
Main Methods:
- A randomized, double-blind, placebo-controlled trial involving 18 preterm infants (mean gestational age 28 weeks).
- Two six-week treatment periods with beclomethasone dipropionate (200 mcg twice daily) or placebo, separated by a two-week washout.
- Daily symptom recording (wheeze, cough, bronchodilator use) and functional residual capacity (FRC) measurements.
Main Results:
- A 37% reduction in symptom score during the active beclomethasone period compared to placebo.
- Infants experienced an average of 28 bronchodilator-free days with beclomethasone versus 22 days with placebo.
- Significant improvement in functional residual capacity (FRC) observed with beclomethasone treatment.
Conclusions:
- Regular inhaled beclomethasone dipropionate is an effective treatment for respiratory symptoms in preterm infants.
- Inhaled steroids offer a beneficial therapeutic option for managing persistent respiratory issues in this cohort.
- The study supports the use of inhaled corticosteroids to improve respiratory outcomes in preterm infants.
Background:
Preterm infants often suffer from recurrent respiratory symptoms at follow up. Although these infants are responsive to treatment with bronchodilators some continue to wheeze or cough despite treatment. In a randomised double blind placebo controlled trial, the ability of inhaled steroids to reduce recurrent respiratory symptoms and the requirement for bronchodilator treatment in preterm infants less than two years of age has been assessed.
Methods:
Eighteen premature infants with mean gestational age 28 weeks and postnatal age 10.5 months were recruited. The study consisted of two six week treatment periods separated by a two week washout period. The infants received either 200 micrograms of beclomethasone dipropionate or placebo as one puff twice daily from an inhaler, through a spacer and a face mask. Parents kept a daily record of their infants' respiratory tract symptoms (wheeze and cough) and use of bronchodilators. Functional residual capacity (FRC) was measured at the beginning and end of each six week period.
Results:
The symptom score was reduced by 37% in the active compared with the placebo period. During the active period the infants had a mean of 28 bronchodilator free days, compared with 22 days in the placebo period. The FRC improved significantly in the active but not the placebo period.
Conclusion:
Regular dosage with beclomethasone by inhalation is a useful treatment for preterm infants with respiratory symptoms.