Early versus late dexamethasone treatment in preterm infants at risk for chronic lung disease: a randomized pilot study

Merz, U; Peschgens, T.; Kusenbach, G.; Hörnchen, H

doi:10.1007/s004310051081

Cited by 32 publications

(21 citation statements)

References 18 publications

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“…While Garland et al. 9 have demonstrated a decreased risk of CLD with early dexamethasone therapy, such an effect was not observed by other groups 24,25 . Moreover, while Yeh et al.…”

Section: Discussionmentioning

confidence: 92%

Intratracheal Administration Of Glucocorticoids Using Surfactant As A Vehicle

Nimmo

Carstairs

Patole

et al. 2002

Clin Exp Pharma Physio

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SUMMARY 1. Glucocorticoids are an effective treatment in the amelioration of chronic lung disease in neonates. However, systemic administration of glucocorticoids to neonates is associated with significant side‐effects that preclude them as an early intervention to prevent onset of the condition. Conversely, local intratracheal administration of glucocorticoids may prevent inflammatory insult to the lungs without the development of systemic side‐effects. We therefore investigated whether local intratracheal delivery of corticosteroids could be facilitated using surfactant as a vehicle. 2. Addition of dexamethasone to either diluted or commercial artificial surfactant, Survanta (Abbott Industries, Sydney, NSW, Australia), did not alter the surface properties of the surfactant. 3. After intratracheal instillation to rats, radiolabelled dexamethasone in Survanta was well distributed throughout all four lobes of the lungs. A concentration gradient of the steroid was observed between the root and the peripheral sections of all lobes. 4. Our results suggest that surfactant is an effective vehicle for intratracheal delivery of glucocorticoids. Moreover, we propose that prophylactic intratracheal administration of glucocorticoids administered shortly after birth may prevent inflammatory insult to the lungs and thereby reduce the likelihood of chronic lung disease developing.

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“…While Garland et al. 9 have demonstrated a decreased risk of CLD with early dexamethasone therapy, such an effect was not observed by other groups 24,25 . Moreover, while Yeh et al.…”

Section: Discussionmentioning

confidence: 92%

Intratracheal Administration Of Glucocorticoids Using Surfactant As A Vehicle

Nimmo

Carstairs

Patole

et al. 2002

Clin Exp Pharma Physio

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“…Lung volume by MBW has allowed clinicians to identify significant air trapping in patients too young to perform conventional PFTs [59] or with obstructive diseases that spirometry does not detect [60]. MBW has been demonstrated to be an important tool in evaluating the effects of medications on preterm neonates, including measuring response to bronchodilator [61], outcomes of infants taking diuretics [62], or in the analysis of the effects of systemic steroids on lung function later in life [63].…”

Section: Clinical Applicationsmentioning

confidence: 99%

Pulmonary Function Testing in Young Children

Escobar

Carver

2011

Curr Allergy Asthma Rep

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Pulmonary function testing (PFT) is of great importance in the evaluation and treatment of respiratory diseases. Spirometry is simple, noninvasive, and has been the most commonly used technique in cooperative children, obtaining reliable data in only a few minutes. The development of commercially available equipment as well as the simplification of previous techniques that now require minimal patient cooperation applied during tidal breathing have significantly stimulated the use of PFT in younger children. Tidal breathing techniques such as impulse oscillometry, gas dilution, and plethysmography have permitted previously unobtainable PFT in children 2 to 5 years of age. The purpose of this review is to help clinicians become familiar with available PFT techniques used in young children by discussing their general principles, clinical applications, and limitations.

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“…The effect of postnatal dexamethasone treatment on FRC pleth was the same for those treated early (day 7) vs. late (>day 14). 49 Despite a reduction in airway resistance and an increase in forced expiratory flows (V 0 maxFRC ), FRC pleth was unaltered by inhaled metaproterenol and atropine in infants with CLD at term equivalent. 46 Likewise, diuretics (chlorothiazide and spironolactone) had a short-term effect on pulmonary mechanics, without altering FRC.…”

Section: The Extent To Which Functional Findings Can Be Related To Pamentioning

confidence: 97%

“…45 This is in contrast to the gross overestimation (by up to 60%) of small lung volumes (50-100 ml) by the earlier generation of a commercially available plethysmograph, as demonstrated in vitro. 14 Consequently, values of FRC pleth as determined in small infants using this equipment [46][47][48][49] should be interpreted with skepticism. Additional factors contributing to overestimation of FRC pleth were reviewed recently.…”

Section: What Are the Limitations And Strengths Of The Individual Tecmentioning

confidence: 99%

Lung Function Tests in Neonates and Infants with Chronic Lung Disease of Infancy: Functional Residual Capacity

Hülskamp¹,

Pillow²,

Dinger³

et al. 2005

Pediatric Pulmonology

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Summary. This is the second paper in a review series that will summarize available data and discuss the potential role of lung function testing in infants and young children with acute neonatal respiratory disorders and chronic lung disease of infancy. The current paper addresses the expansive subject of measurements of lung volume using plethysmography and gas dilution/ washout techniques. Following orientation of the reader to the subject area, we focus our comments on areas of inquiry proposed in the introductory paper to this series. The quality of the published literature is reviewed critically, and recommendations are provided to guide future investigation in this field. Measurements of lung volume are important both for assessing growth and development of lungs in health and disease, and for interpreting volume-dependent lung function parameters such as respiratory compliance, resistance, forced expiratory flows, and indices of gas-mixing efficiency. Acute neonatal lung disease is characterized by severely reduced functional residual capacity (FRC), with treatments aimed at securing optimal lung recruitment. While FRC may remain reduced in established chronic lung disease of infancy, more commonly it becomes normalized or even elevated due to hyperinflation, with or without gas-trapping, secondary to airway obstruction. Ideally, accurate and reliable bedside measurements of FRC would be feasible from birth, throughout all phases of postnatal care (including assisted ventilation), and during subsequent long-term follow-up. Although lung volume measurements in extremely preterm infants were described in a research environment, resolution of several issues is required before such investigations can be translated into routine clinical monitoring. Pediatr

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Early versus late dexamethasone treatment in preterm infants at risk for chronic lung disease: a randomized pilot study

Abstract: Early dexamethasone treatment led to earlier extubation in our study population, but was not associated with significant advantages regarding oxygen dependency at 28 days of life and pulmonary function test at 3 months of age.

Cited by 32 publications

References 18 publications

Intratracheal Administration Of Glucocorticoids Using Surfactant As A Vehicle

Intratracheal Administration Of Glucocorticoids Using Surfactant As A Vehicle

Pulmonary Function Testing in Young Children

Lung Function Tests in Neonates and Infants with Chronic Lung Disease of Infancy: Functional Residual Capacity

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