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JAOA • Vol 104 • No 3 • March 2004 • 114-120
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ORIGINAL CONTRIBUTION

Effect of Inhaled Corticosteroids on Markers of Pulmonary Inflammation and Lung Maturation in Preterm Infants With Evolving Chronic Lung Disease

Nehal A. Parikh, DO; Robert G. Locke, DO; Aaron Chidekel, MD; Kathleen H. Leef, RN, MSN; John Emberger, RRT; David A. Paul, MD; John L. Stefano, MD

From the Department of Pediatrics at Thomas Jefferson University Hospital in Philadelphia, Pa, where Dr Parikh was a fellow in Neonatal/Perinatal Medicine, Ms Leef is a registered nurse, and Mr Emberger is a clinical care coordinator. All other authors have academic appointments through Thomas Jefferson University, where Dr Locke is a clinical associate professor of pediatrics, Dr Paul is an associate professor of pediatrics, Dr Chidekel is an associate professor, and Dr Stefano is a professor of pediatrics and the director of neonatology at Christiana Care Health Services in Newark, Del.

Address correspondence to Nehal A Parikh, DO, Assistant Professor of Pediatrics, University of Texas Health Science Center at Houston, 6431 Fannin St, Ste 3.236B, Houston, TX 77030-1501. Email: nehal.a.parikh{at}uth.tmc.edu

Background: Chronic lung disease (CLD) is one of the most severely disabling conditions of extremely low-birth-weight infants. Systemic corticosteroids are effective but cause many adverse effects. Targeted therapy with inhaled corticosteroids may be an effective and less toxic alternative.

Study Objective: To evaluate the additive effect of inhaled corticosteroids on markers of lung inflammation in infants receiving a 7-day course of systemic steroids.

Methods: Preterm neonates weighing 1 kg or less and aged 12 to 28 days who were prescribed a 7-day course of systemic corticosteroids for evolving CLD were studied prospectively and randomized to receive either a tapering 4-week course of beclomethasone metered-dose inhaler (MDI) (n = 5) or placebo MDI (n = 6). Primary outcome variables were the levels of pro- and anti-inflammatory cytokines, IL-8, TNF-{alpha}, IL-1{alpha}, and sIL-2R.

Results: This study was terminated early following literature reports of the adverse neurodevelopmental effects of dexamethasone. Measurements of respiratory and serum IL-8, IL-1{alpha} and TNF-{alpha} were similar between the study group taking inhaled and systemic corticosteroids and the study group taking systemic steroids alone. No differences were found between the two groups in relation to dynamic compliance or resistance.

Conclusions: The addition of inhaled corticosteroids to a 7-day systemic course of corticosteroids did not alter cytokine response or improve pulmonary function.






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