title: Trial of beclomethasone dipropionate by metered-dose inhaler in ventilator-dependent neonates less than 1500 grams.
abstract: Beclomethasone dipropionate administered by metered-dose inhaler to ventilated infants with early chronic lung disease was evaluated in a double-blind, placebo-controlled study to determine the feasibility and safety of administration. Patients selected for study were less than 1500 g birthweight, had previous radiographic evidence of respiratory distress syndrome with early changes of bronchopulmonary dysplasia (BPD), were greater than 2 weeks of age, and had failed attempts at extubation. The metered-dose inhaler was connected to the respirator circuit by an in-line spacer device and either saline placebo or beclomethasone was delivered for 7 days or until extubated. Beclomethasone was delivered in a dose calculated to be approximately 1 mg/kg/day in three divided doses. Nineteen infants were enrolled. Nine received placebo and 10 received beclomethasone. No adverse effects on blood pressure, heart rate, respiratory rate, ventilator settings, concentration or duration of oxygen therapy, incidence of retinopathy of prematurity (ROP) or infections, blood glucose, daily weight, or serum cortisol levels before and after adrenal stimulation tests were observed in the beclomethasone group compared with the placebo group. One infant in the placebo and six infants in the steroid group were extubated during the study period (p = 0.03). These data indicate that beclomethasone dipropionate may be administered safely to intubated neonates without adverse effects of hypertension, hyperglycemia, diminished weight gain, or adrenal suppression frequently seen with systemic steroid administration. Beclomethasone may enhance extubation in infants with early BPD, however, further data are required to substantiate this preliminary observation.
authors.affiliation: Children's Mercy Hospital, Department of Pediatrics, University of Missouri Kansas City, School of Medicine, 64108, USA.
authors.forename: T
authors.initials: T
authors.lastname: Giep
authors.forename: P
authors.initials: P
authors.lastname: Raibble
authors.forename: T
authors.initials: T
authors.lastname: Zuerlein
authors.forename: I D
authors.initials: ID
authors.lastname: Schwartz
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001424:Bacterial Infections; D001507:Beclomethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D001997:Bronchopulmonary Dysplasia / Q000188:drug therapy; D004311:Double-Blind Method; D005240:Feasibility Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D009330:Nebulizers and Vaporizers; D010102:Oxygen Inhalation Therapy; D010919:Placebos; D012119:Respiration / Q000187:drug effects; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy*; D012178:Retinopathy of Prematurity / Q000209:etiology; D012449:Safety; D012965:Sodium Chloride; D012122:Ventilators, Mechanical
chemical_list: D000893:Anti-Inflammatory Agents; D001786:Blood Glucose; D005938:Glucocorticoids; D010919:Placebos; D012965:Sodium Chloride; D001507:Beclomethasone; D006854:Hydrocortisone