Abstract
Systemic and inhaled dexamethasone treatments have been shown to improve lung mechanics in preterm infants with chronic lung disease. 253 infants were enrolled in a multicenter randomized, placebo-controlled, double-blind clinical trial of early administration of beclomethasone (40μg/kg/day, tapered over 4 weeks) or placebo given by metered dose inhaler and aerochamber® (Mongahan Medical Corp., Inc). These infants were < 33 wks GA and <1251g BW and required assisted ventilation between day 3-14 of life. In 65 of these infants, pulmonary mechanics were measured prior to treatment, and at day 8 and 28. Inhaled steriod (n=34) and placebo group(n=31) had similar BW (833±36 vs 824±33g SD), and GA(26.1±3 vs 26.1±.4wks SD). 44.1% of steroid group received systemic steroid prior to day 28 vs 54.8% of placebo group. Mean±SE values for Tidal Volume (Vt, ml/kg), dynamic compliance (CL, ml/cmH2O), Inspiratory resistance (RI, cmH2O/L/s), Expiratory resistance (RE, cmH2O/L/s), work of breathing (WOB, gm-cm/kg) are reported in the Table below. Both groups had similar lung mechanics at day one (prior to treatment). There was a significant increase in CL over time in both steroid (p<.001) and placebo (p<.01) groups. ANOVA showed no difference in CL between steroid and placebo groups. WOB, RI, and RE did not change over time or between groups. Summary: Early treatment with inhaled beclomethasone shows a trend towards improvement in lung mechanics. A larger sample size is needed to demonstrate significant change.
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