ABSTRACT
Beclomethasone dipropionate administered by metered-dose inhaler to ventilated infants
with early chronic lung disease was evaluated in a double-blind, placebo-controlled
study to determine the feasibility and safety of administration. Patients selected
for study were less than 1500 g birthweight, had previous radiographic evidence of
respiratory distress syndrome with early changes of bronchopulmonary dysplasia (BPD),
were greater than 2 weeks of age, and had failed attempts at extubation. The metered-dose
inhaler was connected to the respirator circuit by an in-line spacer device and either
saline placebo or beclomethasone was delivered for 7 days or until extubated. Beclomethasone
was delivered in a dose calculated to be approximately 1 mg/kg/day in three divided
doses. Nineteen infants were enrolled. Nine received placebo and 10 received beclomethasone.
No adverse effects on blood pressure, heart rate, respiratory rate, ventilator settings,
concentration or duration of oxygen therapy, incidence of retinopathy of prematurity
(ROP) or infections, blood glucose, daily weight, or serum cortisol levels before
and after adrenal stimulation tests were observed in the beclomethasone group compared
with the placebo group. One infant in the placebo and six infants in the steroid group
were extubated during the study period (p = 0.03).
These data indicate that beclomethasone dipropionate may be administered safely to
intubated neonates without adverse effects of hypertension, hyperglycemia, diminished
weight gain, or adrenal suppression frequently seen with systemic steroid administration.
Beclomethasone may enhance extubation in infants with early BPD, however, further
data are required to substantiate this preliminary observation.
Keywords
Beclomethasone dipropionate - ventilated infants - low birthweight neonates - steroids
