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[Respiratory failure after nebulized terbutaline treatment in severely wheezy infants: report of three cases]
1Department of Pediatrics, Taipei Municipal Chung-Hsiao Hospital, Republic of China.
Insights
Nebulized beta-2 agonists can cause respiratory failure in infants with chronic lung disease and wheezing. Premature infants are particularly at risk, requiring careful monitoring during treatment.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Critical Care Medicine
Background:
- Nebulized bronchodilators, particularly beta 2-agonists, are widely used for wheezy infants, despite controversial efficacy in acute asthma.
- Their use is common as first-line treatment in some centers, but potential side effects in young infants are a concern.
Abstract:
Subjective clinical observations have suggested that nebulized bronchodilators are helpful in the treatment of some wheezy infants. Although the role of beta 2-agonists in the management of acute asthma in infants and very young children remains controversial, the use of beta 2-adrenergic agents in this age group has been widespread. beta 2-agonists nebulization continues to be the first-line treatment for acute attack of asthma, irrespective of age, in some institutes, but their uses are not without side effect especially in young wheezy infants. We report three cases of respiratory failure occurred after treatment with nebulized beta 2 bronchodilator in infants with chronic lung disease and acute wheezing. All the 3 cases were victims of prematurity. Case 1 was a case of Wilson-Mikity syndrome; case 2 was a case of bronchopulmonary dysplasia; and case 3 was a case of repeatedly wheezing infant. All 3 cases had severely wheezy dyspnea with retraction before nebulized beta 2 bronchodilator treatment. Respiratory failure was found 5 to 10 minutes after the treatment. We suggest that it must be very careful in the treatment of severely wheezy infants with beta 2-agonist nebulization, especially in cases with histories of prematurity and chronic lung disease. It is necessary to carefully monitor the vital signs of the infants during beta 2 agonist nebulization.