Efficacy and safety of pulmonary application of corticosteroids in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis

Delara, Mahin; Chauhan, Bhupendrasinh F; Le, Mê Linh; Abou‐Setta, Ahmed M; Zarychanski, Ryan; 'tJong, G.W.

doi:10.1136/archdischild-2017-314046

Cited by 22 publications

(15 citation statements)

References 58 publications

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“…One of the limitations of ICS in preterm infants is poor pulmonary deposition due to intrinsically low lung volumes and inspiratory pressures [ 33 , 34 ]. To overcome this limitation, corticosteroids can be instilled into the lungs using surfactant as a vehicle.…”

Section: Postnatal Steroid Management In Preterm Infantsmentioning

confidence: 99%

Postnatal steroid management in preterm infants with evolving bronchopulmonary dysplasia

et al. 2021

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Bronchopulmonary dysplasia (BPD) is a chronic lung disease commonly affecting extremely preterm infants. Although mechanical ventilation and oxygen requirements in premature infants are identified as inciting mechanisms for inflammation and the development of BPD over time, data now support an array of perinatal events that may stimulate the inflammatory cascade prior to delivery. Corticosteroids, such as dexamethasone and hydrocortisone, have proven beneficial for the prevention and management of BPD postnatally due to their anti-inflammatory characteristics. This review aims to examine the pharmacologic properties of several corticosteroids, appraise the existing evidence for postnatal corticosteroid use in preterm infants, and assess steroid management strategies to ameliorate BPD. Finally, we aim to provide guidance based on clinical experience for managing adrenal suppression resulting from prolonged steroid exposure since this is an area less well-studied.

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Section: Postnatal Steroid Management In Preterm Infantsmentioning

confidence: 99%

Postnatal steroid management in preterm infants with evolving bronchopulmonary dysplasia

et al. 2021

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“…About three-quarter of preterm neonates could survive, if they had access to early screening and care [21]. Even though, provision of advanced care for preterm neonates, and mothers; the world health recommendations of surfactant replacement therapy for preterm neonates and corticosteroid administration for mother at risk of preterm birth [22][23][24][25][26][27], care during pregnancy and childbirth [28,29], and high flow of nasal oxygen therapy [30]; the burden of HMD related morbidity and mortality is increasing. Preterm mortality is continuing to be one of the global agendas in the sustainable development goals [31].…”

Section: Introductionmentioning

confidence: 99%

The burden of hyaline membrane disease, mortality and its determinant factors among preterm neonates admitted at Debre Tabor General Hospital, North Central Ethiopia: A retrospective follow up study

et al. 2021

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Background Hyaline membrane disease (HMD) is a leading cause of morbidity and mortality in preterm newborn babies. Though, there are studies related to Hyaline membrane disease inclusive of all neonates, studies related to the burden among preterm neonates were limited. In addition, increasing neonatal mortality in Ethiopia could be related to increase in the burden of hyaline membrane disease among preterm neonates. Therefore, this study was aimed to assess the burden of hyaline membrane disease, mortality and its associated factors among preterm neonate admitted at neonatal intensive care unit, North Central Ethiopia. Methodology An institution-based retrospective follow-up study was conducted among 535 preterm neonates admitted at neonatal intensive care unit from January 1, 2014-December 30, 2017. Data were entered into EPi-data 4.2.0.0 and transferred to STATA version 14 statistical software for statistical analysis. Binary logistic regression was used for the analysis. All variables with P-value < 0.25 during bi-variable analysis were considered for multivariable logistic regression. Level of statistical significance was declared at P value ≤0.05. Results In the current study, proportion of hyaline membrane disease was 40% (95% CI; 35.8, 44.3) of which 49.5% died. Preterm neonate born with Gestational age of less than 34 weeks of age (Adjusted odd ratio (AOR = 2.64; 95 CI: 1.49, 4.66)), 5th minute Apgar score less than 7 (AOR = 2.2; 95% CI: 1.20, 4.07), and newborn with birth weight of less than 1500 gram (AOR = 2.4, 95% CI: 1.3, 4.3) were predictors of hyaline membrane disease. Conclusions The mean gestational age (±) was 33.46 (±2.55) weeks. The incidence of hyaline membrane disease among preterm admissions was high. Preterm neonate born with gestational age of less than 34 weeks of age, asphyxiated newborns and newborn with birth weight of less than 1500 gram were predictors of hyaline membrane disease. So, emphasis should be given on early screening, follow up and timely interventions for preterm neonate.

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“…Therefore, there is a great interest by neonatologists in the development of a truly non-invasive procedure for surfactant administration, such as nebulisation. Some interesting pilot studies have been published on this issue [61,62,63].…”

Section: Formulation Considerationsmentioning

confidence: 99%

“…An advantage of using the pulmonary route is that efficacy can be achieved with reduced systemic drug levels and hence, decreased side effects [64]. For example, a recent review [63] has shown that pulmonary administration of corticosteroids can effectively prevent bronchopulmonary dysplasia in preterm infants with RSD, without the adverse effects on growth and neurodevelopmental outcome associated with systemic delivery. An emerging practice consists of adding budenoside to surfactant [65].…”

Section: Formulation Considerationsmentioning

confidence: 99%

Making Medicines Baby Size: The Challenges in Bridging the Formulation Gap in Neonatal Medicine

O’Brien

Clapham²,

Krysiak

et al. 2019

IJMS

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The development of age-appropriate formulations should focus on dosage forms that can deliver variable yet accurate doses that are safe and acceptable to the child, are matched to his/her development and ability, and avoid medication errors. However, in the past decade, the medication needs of neonates have largely been neglected. The aim of this review is to expand on what differentiates the needs of preterm and term neonates from those of the older paediatric subsets, in terms of environment of care, ability to measure and administer the dose (from the perspective of the patient and carer, the routes of administration, the device and the product), neonatal biopharmaceutics and regulatory challenges. This review offers insight into those challenges posed by the formulation of medicinal products for neonatal patients in order to support the development of clinically relevant products.

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Efficacy and safety of pulmonary application of corticosteroids in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis

Abstract: Pulmonary administration of corticosteroids reduces the incidence of BPD or death, pneumonia, PDA without causing any major side effects in preterm infants with RDS.

Cited by 22 publications

References 58 publications

Postnatal steroid management in preterm infants with evolving bronchopulmonary dysplasia

Postnatal steroid management in preterm infants with evolving bronchopulmonary dysplasia

The burden of hyaline membrane disease, mortality and its determinant factors among preterm neonates admitted at Debre Tabor General Hospital, North Central Ethiopia: A retrospective follow up study

Making Medicines Baby Size: The Challenges in Bridging the Formulation Gap in Neonatal Medicine

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