title: Efficacy and tolerance of high-dose inhaled ipratropium bromide vs. terbutaline in intubated premature human neonates.
abstract: BACKGROUND
  There is insufficient data to reliably assess the benefit of bronchodilators in ventilated premature neonates.
  
  
  OBJECTIVE
  To compare the efficacy/tolerance of inhaled ipratropium bromide (IB) vs. terbutaline (T) and to describe factors associated with their efficacy.
  
  
  METHODS
  A cross-over randomized controlled double-blind trial including intubated neonates with respiratory distress syndrome. Two puffs of IB or T were administered at 0, 20, 40 min. Passive respiratory system resistance (Rrs) and compliance (Crs) were measured at 0, 20, 40, 60 min. A positive response was defined as a >2 individual coefficients of variation decrease in Rrs or increase in Crs.
  
  
  RESULTS
  Twenty-one infants (gestational age (mean +/- SD): 27.3 +/- 1.6 weeks; birth weight: 947 +/- 250 g; postnatal age: 20 +/- 9 days) were included. At 60 min, no treatment effect for Rrs and Crs could be identified (cross-over analysis). Overall data (irrespective of order of administration) showed that after 6 puffs, the decrease in Rrs was greater in the IB vs. T group (-17.0 +/- 22.2% vs. -11.3 +/- 26.7%, respectively (NS)). Thirty-eight percent of infants responded to IB vs. 43% to T. However, in 19% of patients, decreased Crs was observed after 6 puffs of T. No marker of a positive or paradoxical response could be identified. Treatment was well-tolerated.
  
  
  CONCLUSIONS
  High doses of bronchodilators are required in ventilated neonates, but the positive response rate was <50%. Their long-term benefit remains to be proven.
authors: Department of Pediatrics and Centre de Recherche (CEDRE), Hôpital Pellegrin-Enfants, CHU de Bordeaux, Bordeaux, France. michael.fayon@chu-bordeaux.fr
authors: Michael
authors: M
authors: Fayon
authors: Nawar
authors: N
authors: Tayara
authors: Christine
authors: C
authors: Germain
authors: Marie-Luce
authors: ML
authors: Choukroun
authors: Eric Dumas
authors: ED
authors: De La Roque
authors: Geneviève
authors: G
authors: Chêne
authors: Dominique
authors: D
authors: Breilh
authors: Roger
authors: R
authors: Marthan
authors: Jean-Louis
authors: JL
authors: Demarquez
mesh_terms: D000280:Administration, Inhalation; D000403:Airway Resistance / Q000187:drug effects / Q000502:physiology; D001724:Birth Weight; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D009241:Ipratropium / Q000627:therapeutic use*; D008170:Lung Compliance / Q000187:drug effects / Q000502:physiology; D008297:Male; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000503:physiopathology; D013726:Terbutaline / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D009241:Ipratropium; D013726:Terbutaline