EFFICACY OF SEQUENTIAL EARLY SYSTEMIC AND INHALED CORTICOSTEROID-THERAPY IN THE PREVENTION OF CHRONIC LUNG-DISEASE OF PREMATURITY

In order to assess the efficacy of a combination of systemic and nebul ized corticosteroids in reducing the incidence and severity of chronic lung disease (CLD) in very low birthweight (VLBW) infants, 60 ventila tor-dependent infants less than or equal to 1500 g were randomly assig ned to receive either steroids or placebo as of 7 d. The steroid group (n = 30, GA = 25.8 +/- 1.6 weeks, BW = 731 +/- 147 g) received system ic dexamethasone for 3 d, followed by nebulized budesonide for 18 d. C ontrol infants (n = 30, GA = 25.9 +/- 1.8 weeks, BW = 796 +/- 199 g) r eceived systemic and inhaled saline. Steroid-treated infants required less ventilatory support between 9 and 17 d (p < 0.01), and had greate r lung compliance at 10 d (p = 0.01), but not subsequently. CLD incide nce at 36 weeks was 45.5% vs 56.0% in controls, and fewer steroid-trea ted infants required dexamethasone rescue (23.3% vs 56.7%, p = 0.017). Survival to discharge was similar (73.3% vs 83.3%), as were the durat ions of mechanical ventilation, supplemental oxygen use, and hospitali zation. Tracheal effluent elastase/albumin ratios and serum cortisol v alues did not differ between groups, and no adverse effects were noted . We conclude that early dexamethasone administration was associated w ith improved pulmonary function, which was not sustained with nebulize d budesonide. However, the steroid regimen studied reduced the need fo r dexamethasone rescue in infants with CLD.