Survey of practices regarding utilization of inhaled steroids in 223 German neonatal units.
BACKGROUND
No survey has been published in recent years which primarily focuses on the prescription of inhaled corticosteroids in neonatal practice. Thus, the utilization rate of inhaled corticosteroids is unknown.


OBJECTIVE
To elucidate the current utilization rate of inhaled corticosteroids in the prevention and therapy of bronchopulmonary dysplasia (BPD).


METHODS
We developed an 18-item questionnaire that was distributed in March 2009, via electronic mail, to the pediatricians-in-chief of all the 343 German pediatric hospitals with a neonatal unit (all levels of neonatal care). We sent electronic reminders after 4 and 8 weeks.


RESULTS
223 hospitals (65%) returned the questionnaire. Of these, 102 (46%) administered inhaled corticosteroids to premature infants either as prophylaxis or treatment for BPD. Predominantly, treatment with inhaled steroids was seen as a 'rescue therapy' and used only if other therapeutic approaches had failed. Of the hospitals not administering inhaled steroids, the most frequently stated reason was 'insufficient robust evidence to support benefit of therapy' (57%). In the majority of hospitals (81%), the active substance of choice was budesonide.


CONCLUSIONS
Of the responders, approximately 50% administer inhaled corticosteroids to premature infants either as a prophylaxis or treatment for BPD. Lack of beneficial evidence was the main reason for not administering inhaled steroids in about half of the units which took this approach. Future trials should address this discrepancy by aiming to establish a clear benefit-risk ratio of inhaled corticosteroids.
Department of Neonatology, University Children's Hospital, Tübingen, Germany.
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Maas
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Poets
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Bassler
D000280:Administration, Inhalation; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003625:Data Collection; D004334:Drug Administration Schedule; D005858:Germany; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D015931:Intensive Care, Neonatal / Q000379:methods*; D008171:Lung Diseases; D010372:Pediatrics / Q000379:methods*; D011364:Professional Practice; D011795:Surveys and Questionnaires
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids