Randomised controlled study of early use of inhaled corticosteroid in preterm infants with respiratory distress syndrome.
OBJECTIVE
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 microg/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.


CONCLUSIONS
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.
Fok
T F
TF
Department of Paediatrics Prince of Wales Hospital The Chinese University of Hong Kong ShatinHong Kong People's Republic of China. taifaitok@cuhk.edu
Lam
K
K
Dolovich
M
M
Ng
P C
PC
Wong
W
W
Cheung
K L
KL
So
K W
KW
D000280:Administration, Inhalation; D000704:Analysis of Variance; D000730:Androstadienes / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000068298:Fluticasone; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000628:therapy
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D000068298:Fluticasone