Intratracheal Administration of Budesonide/Surfactant to Prevent Bronchopulmonary Dysplasia

TLDR

Bronchopulmonary dysplasia is a major complication of mechanical ventilation in preterm infants, with no definitive therapy, and pulmonary inflammation is a key driver of its pathogenesis. The study aimed to compare the effect of intratracheal surfactant combined with budesonide versus surfactant alone on the incidence of death or BPD. In a multicenter randomized controlled trial of 265 very‑low‑birth‑weight infants with severe respiratory distress syndrome, the intervention group received surfactant (100 mg/kg) plus budesonide (0.25 mg/kg) until oxygen saturation fell below 30 % or the infant was extubated, while the control group received surfactant alone. The surfactant/budesonide group had a significantly lower incidence of BPD or death (42 % vs 66 %, RR 0.58, P < 0.001), required fewer surfactant doses, and showed reduced tracheal aspirate interleukin‑1, –6, and –8 levels. The trial was registered at ClinicalTrials.gov (NCT‑00883532).

Abstract

Bronchopulmonary dysplasia (BPD) is an important complication of mechanical ventilation in preterm infants, and no definite therapy can eliminate this complication. Pulmonary inflammation plays a crucial role in its pathogenesis, and glucocorticoid is one potential therapy to prevent BPD.To compare the effect of intratracheal administration of surfactant/budesonide with that of surfactant alone on the incidence of death or BPD.A clinical trial was conducted in three tertiary neonatal centers in the United States and Taiwan, in which 265 very-low-birth-weight infants with severe respiratory distress syndrome who required mechanical ventilation and inspired oxygen (fraction of inspired oxygen, ≥50%) within 4 hours of birth were randomly assigned to one of two groups (131 intervention and 134 control). The intervention infants received surfactant (100 mg/kg) and budesonide (0.25 mg/kg), and the control infants received surfactant only (100 mg/kg), until each infant required inspired O2 at less than 30% or was extubated.The intervention group had a significantly lower incidence of BPD or death (55 of 131 [42.0%] vs. 89 of 134 [66%]; risk ratio, 0.58; 95% confidence interval, 0.44-0.77; P < 0.001; number needed to treat, 4.1; 95% confidence interval, 2.8-7.8). The intervention group required significantly fewer doses of surfactant than did the control group. The intervention group had significantly lower interleukin levels (IL-1, IL-6, IL-8) in tracheal aspirates at 12 hours and lower IL-8 at 3-5 and 7-8 days.In very-low-birth-weight infants with severe respiratory distress syndrome, intratracheal administration of surfactant/budesonide compared with surfactant alone significantly decreased the incidence of BPD or death without immediate adverse effect. Clinical trial registered with www.clinicaltrials.gov (NCT-00883532).