A randomized trial of inhaled versus intravenous steroids in ventilator-dependent preterm infants.
OBJECTIVE
Intravenous steroids improve the respiratory course in ventilator-dependent preterm infants but have adverse effects. We hypothesized that inhaled steroids would be as effective, but with less systemic effects.


METHODS
We conducted a randomized, prospective trial comparing inhaled beclomethasone, either 400 or 800 microg/d, to intravenous dexamethasone in preterm infants dependent on conventional mechanical ventilation and supplemental oxygen at 2 weeks of age.


RESULTS
Seventy-eight infants were randomized. By day three of therapy, the intravenous steroid group had significantly decreased ventilator and oxygen requirements compared to either inhaled group. The inhaled 800-microg/d group trended toward more rapid decreases in ventilator and oxygen requirements than the 400-microg/d group. By day 14, all groups had similar reductions in ventilator and oxygen requirements. The incidence of adverse effects did not differ between groups.


CONCLUSIONS
In this small, randomized study, inhaled steroids conferred no advantages to intravenous steroids in the management of ventilator-dependent preterm infants.
Suchomski
Sandra J
SJ
Department of Pediatrics, Children's Hospital of Buffalo, Buffalo, NY, USA.
Cummings
James J
JJ
D000280:Administration, Inhalation; D001507:Beclomethasone / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D007262:Infusions, Intravenous; D008297:Male; D011446:Prospective Studies
D005938:Glucocorticoids; D003907:Dexamethasone; D001507:Beclomethasone