Effects of inhaled corticosteroids on systemic blood pressure in preterm infants.
OBJECTIVE
To assess the effect of inhaled fluticasone propionate on (i) systemic blood pressure, and (ii) the need for volume expanders (crystalloids and colloids) and inotropes for blood pressure support in preterm, very low birth weight (VLBW) infants.


METHODS
Ventilated VLBW infants, less than 32 weeks of gestation, with respiratory distress syndrome were randomised to receive a 14-day course of either fluticasone propionate (500 microg/puff, 2 puffs every 12 h; n=27) or placebo (n=26) with a metered dose inhaler-spacer device. The response of treatment was assessed by comparing the use of volume expanders, inotropes, and the average and the lowest systolic, mean and diastolic blood pressures in 6 hourly epochs between the 2 groups.


RESULTS
There were no significant differences in the average or the lowest systolic, mean and diastolic blood pressures in 6 hourly epochs between the 2 groups. However, the total volume of crystalloids and colloids requirement was significantly greater in control than in treated infants (p=0.03). There was also a trend towards greater consumption of the total cumulative dose of dopamine in the control infants (p=0.10).


CONCLUSIONS
Fluticasone-treated infants required significantly less volume of crystalloids and colloids for blood pressure support compared with control infants. Further larger scale studies are required to determine whether inhaled corticosteroids could minimise the use of volume replacement therapy and inotropes in the treatment of hypotension in preterm infants in the early postnatal period.
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Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong. pakcheungng@cuhk.edu.hk
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Liu
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Lee
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Ma
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Wong
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D000280:Administration, Inhalation; D000309:Adrenal Insufficiency / Q000188:drug therapy; D000730:Androstadienes / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects*; D001810:Blood Volume; D003102:Colloids / Q000008:administration & dosage; D000077324:Crystalloid Solutions; D003971:Diastole; D004280:Dobutamine / Q000008:administration & dosage; D004298:Dopamine / Q000008:administration & dosage; D000068298:Fluticasone; D005865:Gestational Age; D006801:Humans; D007022:Hypotension / Q000188:drug therapy; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy*; D019102:Infant, Very Low Birth Weight; D007552:Isotonic Solutions; D010919:Placebos; D010952:Plasma Substitutes / Q000008:administration & dosage; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications; D013599:Systole
D000730:Androstadienes; D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010919:Placebos; D010952:Plasma Substitutes; D004280:Dobutamine; D000068298:Fluticasone; D004298:Dopamine