Making Babies Breathe Better—Hopeful Signals?: Commentary on articles by Minocchieri et al. on page 141, and Sood et al. on page 159

Bhandari, Vineet

doi:10.1203/PDR.0b013e31818071cf

Commentary
Published: August 2008

Making Babies Breathe Better—Hopeful Signals?: Commentary on articles by Minocchieri et al. on page 141, and Sood et al. on page 159

Vineet Bhandari^1,1

Pediatric Research volume 64, pages 123–124 (2008)Cite this article

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The issue of delivery and effectiveness of nongaseous medications via the airway into the lungs of babies is an area of significant clinical interest. The advantages are quite obvious: if a medication can be efficiently delivered to reach the distal areas of the lung and have an effective response to ameliorate or prevent lung disease, with minimal systemic adverse effects, it would be ideal (1). While effective medications have been developed for aerosol delivery targeted for a variety of pulmonary disorders (steroids for asthma, gentamicin for cystic fibrosis), a majority of them have only proven efficacious in adults or older children. Understanding the unique circumstances of the neonate deserves independent in vitro modeling and in vivo assessments and not mathematical extrapolation of data derived from adults and/or older children (2).

The efficacy of an aerosolized medication is dependent upon the targeted delivery of an adequate dose to the sites in the lung for maximum effectiveness. Factors influencing this include aerosol particle size, the neonate's respiratory status, the underlying pulmonary disease, the aerosol delivery system and its method of use (2). With in vitro studies using jet nebulizers, improvements have been made that have translated to increased aerosol delivery in vivo. These include decreased particle size, low inspiratory flow, high tidal volumes, nonhumidified ventilator circuits, and administration times of up to 40 min (3). While these improve aerosol delivery, the use of high tidal volumes and cold and dry gases is of significant clinical concern in such circumstances. It is hoped that there will be further advancements in nebulizer therapy (4). While increasing aerosol efficiency is able to deliver 15–22% of a medication in adults (2,5,6), in low birth weight infants, it is consistently <2% (2,7). A suggested improvement for jet nebulizer efficiency has been attempted in an in vitro study applicable to ventilated neonates, but requires comprehensive evaluation before attempting clinical implementation (8). Currently, the majority of neonatal intensive care units prefer to use a metered dose inhaler to deliver albuterol aerosol (9) given its superiority over a nebulizer (10–13).

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Department of Pediatrics, Yale University School of Medicine, New Haven, 06520, Connecticut
Vineet Bhandari & Vineet Bhandari

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Bhandari, V. Making Babies Breathe Better—Hopeful Signals?: Commentary on articles by Minocchieri et al. on page 141, and Sood et al. on page 159. Pediatr Res 64, 123–124 (2008). https://doi.org/10.1203/PDR.0b013e31818071cf

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Received: 24 April 2008
Accepted: 26 April 2008
Issue date: August 2008
DOI: https://doi.org/10.1203/PDR.0b013e31818071cf

Making Babies Breathe Better—Hopeful Signals?: Commentary on articles by Minocchieri et al. on page 141, and Sood et al. on page 159

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