Abstract
Background. Glucocorticoids have been used successfully in the amelioration of chronic lung disease (CLD). Unfortunately, higher risk of adverse neurological outcome has been reported in newborns treated with systemic steroids. The ideal treatment of CLD would be a topical steroid with a low absorption given directly to the alveoli so improving clinical efficacy and decreasing side effects. Inhaled steroids have been used at this purpose but drug delivery was extremely variable ranging from 0.04 to 53.2%. Exogenous surfactant has been proposed as a possible vehicle for drugs such as antibiotics. Recently, it has been shown to be a good vehicle for steroids too, while maintaining its surface properties. We report a case of extremely severe respiratory insufficiency in a newborn affected by CLD in which a combined treatment with Curosurf® and beclomethasone was used.
Case report. Male newborn, outborn, 495 g BW, GA 24 weeks born by cesarean section due to abruptio placentae. No antenatal steroids were given. He was intubated at birth and mechanically ventilated (MV). A prophylactic dose of Curosurf® was given. A patent ductus arteriosus was closed by i.v. ibuprofen. No others cardiac defects were present. Because of respiratory deterioration on the 2nd week of life (requirement of supplemental oxygen increased to 80% in MV) he received dexamethasone at tapering doses for 10 days. Microbiological cultures remained sterile. At the end of treatment no relevant improvement was seen, requirement for supplemental oxygen was 0.9–1 in MV. Chest X-ray showed severe CLD with a cystic pattern. Diverse treatment strategies such as low dose nitric oxide, Curosurf® instillation, bronchoalveolar lavage, chest physiotherapy were used without effect. On the 44th day of life due to respiratory deterioration and intractable hypoxemia (tcSatO2 75–85% with FiO2 1 in SIPPV, PIP 25 cmH2O, paO2 31.7 mmHg) parental consent was obtained and the newborn was treated with a mixture of Curosurf® (80 mg/kg) and beclomethasone (400 mcg/kg). Few hours after treatment the tcSatO2 was >90%, paO2 69 mmHg with FiO2 0.85. Treatment was continued for 6 days; the newborn remained stable, with a normal oxygenation in SIPPV (FiO2 0.85–1). There were no adverse effects during treatment. Systemic betamethasone was continued at tapering doses for others 10 days. He was extubated on the 70th day of life on nCPAP and later on reintubated several times to be broncho-aspirated. He was discharged at 3 months of age without supplemental oxygen. Cranial US shows no anomalies.
Conclusions. Surfactant may be a useful vehicle for steroid administration in the prevention and treatment of CLD. This treatment has not shown short term adverse effects and has permitted survival in our extremely ill patient. Further studies are needed in order to evaluate the usefulness and safety of this approach.
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Ancora, G., Sandri, F., Marvulli, L. et al. 7 Combined Treatment with Curosurfá and Beclomethasone in an Elbwi Affected by Severe Chronic Lung Disease. Pediatr Res 58, 355 (2005). https://doi.org/10.1203/00006450-200508000-00036
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DOI: https://doi.org/10.1203/00006450-200508000-00036
