Randomised controlled study of early use of inhaled corticosteroid in preterm infants with respiratory distress syndrome

Aim-To investigate the therapeutic efficacy of inhaled fluticasone propiona te, started on day 1 of age, on ventilated preterm infants with respiratory distress syndrome. Methods-Starting within 24 hours of age, ventilated preterm infants (gestat ion < 32 weeks, birthweight < 1.5 kg) with respiratory distress syndrome we re given a 14 day course (two puffs, 12 hourly) of either fluticasone propi onate (250 mu g/puff) (group 1, n=27) or placebo (group 2, n=26) with a met ered dose inhaler-spacer device. Response to treatment was assessed by the rate of successful extubation by days 7 and 14 of age, changes in respirato ry system mechanics, death, occurrence of chronic lung disease, and other n eonatal complications. Results-More infants in the treatment group were successfully extubated by 14 days of age than those in the placebo group (17/27 vs 8/26; p = 0.038). The treated infants also showed a more significant improvement in respirato ry system compliance during the first 14 days of life. The two groups, howe ver, did not differ significantly in their need for systemic steroids after day 14 of age, death, or the occurrence of chronic lung disease. The treat ment was not associated with any increase in neonatal complications, includ ing those attributable to steroid induced side effects, Conclusion-These results provide preliminary evidence that early treatment with inhaled corticosteroids may be beneficial to ventilated preterm infant s with respiratory distress. Further study of its use in a large scale rand omised trial is warranted.