title: The use of inhaled glucocorticosteroids and recovery from adrenal suppression after systemic steroid use in a VLBW premature infant with BPD: case report and literature discussion.
abstract: Despite development of many prevention and treatment modalities for bronchopulmonary dysplasia (BPD), a form of chronic respiratory insufficiency in premature infants recovering from respiratory distress syndrome, BPD remains a treatment challenge and a significant cause of long-term morbidity. A ventilator-dependent very low birth weight infant in our newborn special care unit was receiving multiple courses of systemic dexamethasone for severe respiratory failure. The infant demonstrated adrenal suppression manifested by a baseline cortisol concentration below reported levels in infants of similar birth weight and postnatal age. We hypothesized that he had developed adrenal insufficiency as a result of the prolonged systemic steroid administration used to treat his respiratory problems. We further hypothesized that inhaled beclomethasone therapy would aid in the infant's recovery phase during relative adrenal insufficiency--and so substituted inhaled for systemic steroids. Inhaled corticosteroid treatment improved the clinical respiratory course and postnatal growth of this premature infant with BPD without inhibiting his recovery from adrenal insufficiency.
authors.affiliation: Department of Pediatrics, Women & Infants' Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905-2401, USA. dkarinsk@wihri.org
authors.forename: D A
authors.initials: DA
authors.lastname: Karinski
authors.forename: D
authors.initials: D
authors.lastname: Balkundi
authors.forename: L P
authors.initials: LP
authors.lastname: Rubin
authors.forename: J F
authors.initials: JF
authors.lastname: Padbury
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000311:Adrenal Glands / Q000187:drug effects; D000328:Adult; D001623:Betamethasone / Q000008:administration & dosage / Q000009:adverse effects*; D001688:Biological Products; D001997:Bronchopulmonary Dysplasia / Q000188:drug therapy* / Q000209:etiology / Q000451:nursing*; D002585:Cesarean Section; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007275:Injections, Intravenous; D007363:Intensive Care Units, Neonatal; D008297:Male; D011175:Positive-Pressure Respiration; D011247:Pregnancy; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D001688:Biological Products; D011663:Pulmonary Surfactants; D001623:Betamethasone; C072197:beractant