Effects of inhaled beclomethasone compared to systemic dexamethasone on lung inflammation in preterm infants at risk of chronic lung disease

The purpose of this study was to compare the effects of daily inhaled beclo methasone (3 x 500 mu g) started on day 3 of life, with that of systemic de xamethasone (0.5 mg/kg/day) started between days 11-13 on clinical variable s, lung inflammation, and pulmonary microvascular permeability in preterm i nfants at risk for chronic lung disease (CLD). Following administration of surfactant, preterm neonates with RDS and a birth weight of less than 1,200 g were included in this comparative observational pilot study when still m echanically ventilated and with an oxygen requirement on the third day of l ife. The patients (gestational age 26.1 +/- 0.9 weeks, birth weight 826 +/- 140 g, mean SD) were alternately allocated to prophylactic treatment with inhaled beclomethasone (n = 7), or to early systemic dexamethasone therapy after day 10 of life, if clinically indicated (n = 9). Pulmonary inilammati on and lung permeability were assessed by analyzing the levels of interleuk in-8, elastase alpha(1) proteinase inhibitor, free elastase activity, and a lbumin in tracheal aspirates on days 10 and 14 of life. The secretory compo nent of IgA served as reference protein. We observed no significant differences in the concentrations of interleukin -8, elastase alpha(1) proteinase inhibitor, and albumin between the two gro ups on day 10 of life. On day 14, 3 (median; range, 1-3) days following ini tiation of dexamethasone treatment, concentrations of the inflammatory medi ators and of albumin were significantly lower in the group on systemic ster oid therapy than in the group treated with inhaled steroids (P < 0.01). Add itionally, there was a significant difference in oxygen requirements betwee n both groups on day 14. In the group treated with inhaled steroids, concen trations of the inflammatory mediators, albumin, and oxygen requirements di d not show a difference between day 10 and 14. We conclude that, in contrast to systemic dexamethasone treatment, a 12-day course of inhaled beclomethasone does not affect lung inflammation and pul monary microvascular permeability in preterm infants at risk for CLD within the first 2 weeks of life. Pediatr Pulmonol. 1999; 27:383-387. (C) 1999 Wi ley-Liss, Inc.