T Brett Kothe1,2, Farouk H Sadiq1, Nikki Burleyson3, Howard L Williams3, Connie Anderson1, Noah H Hillman4. 1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO, USA. 2. Division of Neonatology, Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, TN, USA. 3. SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA. 4. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO, USA. Noah.Hillman@health.slu.edu.
Abstract
BACKGROUND: In preterm infants on moderately high ventilator support, the addition of budesonide to surfactant lowered bronchopulmonary dysplasia (BPD) rates by 20% without increased morbidity or mortality. The aim of this cohort comparison was to determine the safety and efficacy of the combination in infants with milder respiratory distress syndrome (RDS). METHODS: In August 2016 we began administering budesonide (0.25 mg/kg) mixed with surfactant (Survanta 4 mL/kg) to all infants ≤ 1250 g who failed CPAP and required intubation. Infants were compared to a historical cohort (2013-2016) who received surfactant alone. RESULTS: BPD or death did not change between the historical surfactant cohort (71%, n = 294) and the budesonide cohort (69%, n = 173). Budesonide was associated with a decrease in the need for continued mechanical ventilation, severe BPD type II or death (19-12%), grade III BPD or death (31-21%), and the median gestational age at discharge was 1 week earlier. Histologic chorioamnionitis was associated with decreased budesonide effects. Secondary morbidities (NEC, IVH, ROP, Sepsis) were similar. CONCLUSION: Overall BPD rates remained unchanged with the addition of budesonide. Budesonide was associated with decreased severity of BPD, decreased mechanical ventilation use, earlier discharge, and similar short-term outcomes.
BACKGROUND: In preterm infants on moderately high ventilator support, the addition of budesonide to surfactant lowered bronchopulmonary dysplasia (BPD) rates by 20% without increased morbidity or mortality. The aim of this cohort comparison was to determine the safety and efficacy of the combination in infants with milder respiratory distress syndrome (RDS). METHODS: In August 2016 we began administering budesonide (0.25 mg/kg) mixed with surfactant (Survanta 4 mL/kg) to all infants ≤ 1250 g who failed CPAP and required intubation. Infants were compared to a historical cohort (2013-2016) who received surfactant alone. RESULTS:BPD or death did not change between the historical surfactant cohort (71%, n = 294) and the budesonide cohort (69%, n = 173). Budesonide was associated with a decrease in the need for continued mechanical ventilation, severe BPD type II or death (19-12%), grade III BPD or death (31-21%), and the median gestational age at discharge was 1 week earlier. Histologic chorioamnionitis was associated with decreased budesonide effects. Secondary morbidities (NEC, IVH, ROP, Sepsis) were similar. CONCLUSION: Overall BPD rates remained unchanged with the addition of budesonide. Budesonide was associated with decreased severity of BPD, decreased mechanical ventilation use, earlier discharge, and similar short-term outcomes.
Authors: Justin B Josephsen; Brianna M Hemmann; Connie D Anderson; Brett M Hemmann; Paula M Buchanan; Howard L Williams; Lisa M Lubsch; Noah H Hillman Journal: J Perinatol Date: 2021-11-01 Impact factor: 2.521
Authors: Xinhui Wu; I Sophie T Bos; Thomas M Conlon; Meshal Ansari; Vicky Verschut; Luke van der Koog; Lars A Verkleij; Angela D'Ambrosi; Aleksey Matveyenko; Herbert B Schiller; Melanie Königshoff; Martina Schmidt; Loes E M Kistemaker; Ali Önder Yildirim; Reinoud Gosens Journal: Sci Adv Date: 2022-03-23 Impact factor: 14.136
Authors: Riccardo Zecchi; Pietro Franceschi; Laura Tigli; Barbara Pioselli; Valentina Mileo; Xabier Murgia; Fabrizio Salomone; Giuseppe Pieraccini; Haruo Usada; Augusto F Schmidt; Noah H Hillman; Matthew W Kemp; Alan H Jobe Journal: Pharmaceutics Date: 2021-06-12 Impact factor: 6.321