Comparison of Intravenous Dexamethasone and Budesonide Nebulizer in the Treatment of Infantile Respiratory Distress Syndrome; A Randomized Clinical Trial

Document Type : Original Article

Authors

1 Department of Pediatrics, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 Student Research Committee (SRC), Baqiyatallah University of Medical Sciences, Tehran, Iran

3 Chemical Injury Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

Abstract

Background: Respiratory distress syndrome (RDS) is one of the most common causes of mortality in preterm infants. Despite appropriate results of corticosteroids prescription for preventing RDS, early use of these medications after birth has raised concerns about short and long-term complications. Inhaler corticosteroids have lower systemic absorption and have been considered to decrease short and long term complications of systemic corticosteroids to minimum.

Objectives: In this randomized clinical trial we aimed to assess effectiveness of intravenous dexamethasone and budesonide nebulizer in treatment of infantile respiratory distress syndrome.

Methods: In this randomized clinical trial preterm infants with confirmed diagnosis of RDSwere randomly allocated to two groups; the first group received intravenous Dexamethasone (0.15 mg/kg every 12 hours) and the second group received Budesonide nebulizer (200 μg/ day) through jet nebulizer. Treatment duration, complicationsand received doses as well as response to treatment and mortality rates were recorded in a checklist.

Results: Finally 60 infants (35 female and 25 male) in Budesonide and Dexamethasone groups underwent analysis. Mean arterial oxygen saturation was 88.60±3.21 % in Budesonide and 88.13±3.73% in Dexamethasone group before intervention (p=0.606). In the fifth day of intervention it was 93.80±2.14% in Budesonide and 93.25±3.76 in Dexamethasone group (p=0.441). Prior to intervention, Budesonide group had a mean respiratory rate (RR) of 71.50±12.33 and it was 67.17±12.84 in Dexamethasone group (p=0.188). In the fifth day of intervention, infants had a mean RR of 45.66±8.87 in Budesonide and 48.21±10.11 in Dexamethasone group (p= 0.179). Mean hospitalization duration was 16.36±11.32 days in Dexamethasone and 17.40±14.39 in Budesonide group (p=0.758).

Conclusion: We concluded that there is no significant difference between intravenous Dexamethasone and Budesonide nebulizer for treatment of infantile RDS.

Keywords

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

References

1. Kliegman RM, Behrman RE, Nelson WE. Nelson textbook of pediatrics. New York: Elsevier Health Sciences; 2016.
 
2. Najafian B, Esmaeili B, Khosravi MH. Comparison of fentanyl and midazolam for the sedation of infants under mechanical ventilation; a randomized clinical trial. Hosp Pract Res. 2017;2(3):63-7.
https://doi.org/10.15171/hpr.2017.17
 
3. Najafian B, Karimi-Sari H, Khosravi MH, Nikjoo N, Amin S, Shohrati M. Comparison of efficacy and safety of two available natural surfactants in Iran, Curosurf and Survanta in treatment of neonatal respiratory distress syndrome: a randomized clinical trial. Contemp Clin Trials Commun. 2016;3:55-9.
https://doi.org/10.1016/j.conctc.2016.04.003
PMid:29736457 PMCid:PMC5935855
 
4. Najafian B, Khosravi MH, Setayesh F, Shohrati M. Comparing the effect of inhaler N-acetyl cysteine and intravenous dexamethasone on respiratory distress syndrome in premature infants: a randomized clinical trial. Thrita. 2017;6(1):e46268.
https://doi.org/10.5812/thrita.46268
 
5. Wang L, Chen L, Li R, Zhao J, Wu X, Li X, et al. Efficacy of surfactant at different gestational ages for infants with respiratory distress syndrome. Int J Clin Exper Med. 2015; 8(8):13783-9. [PubMed: 26550326].
 
6. Najafian B, Eyvazloo H, Khosravi MH. Effects of different doses of fentanyl on the sedation of infants under mechanical ventilation; a randomized clinical trial. Hosp Pract Res. 2017;2(4):109-12.
https://doi.org/10.15171/hpr.2017.26
 
7. Soll R, Özek E. Multiple versus single doses of exogenous surfactant for the prevention or treatment of neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2009;1:CD000141.
https://doi.org/10.1002/14651858.CD000141.pub2
 
8. Doyle LW, Ehrenkranz RA, Halliday HL. Dexamethasone treatment in the first week of life for preventing bronchopulmonary dysplasia in preterm infants: a systematic review. Neonatology. 2010;98(3):217-24.
https://doi.org/10.1159/000286210
PMid:20389126
 
9. Halliday HL. Perinatal corticosteroid treatment-helpful or harmful. Arch Perinat Med. 2000;6:7-9.
 
10. Speer CP. Chorioamnionitis, postnatal factors and proinflammatory response in the pathogenetic sequence of bronchopulmonary dysplasia. Neonatology. 2009;95(4):353- 61.
https://doi.org/10.1159/000209301
PMid:19494557
 
11. Doyle LW, Ehrenkranz RA, Halliday HL. Early (< 8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. CochraneDatabaseSyst Rev. 2014; 5:CD001146.
https://doi.org/10.1002/14651858.CD001146.pub4
 
12. Dimitriou G, Greenough A, Giffin FJ, Kavadia V. Inhaled versus systemic steroids in chronic oxygen dependency of preterm infants. Eur J Pediatr. 1996;156(1):51-5. [PubMed: 9007492].
https://doi.org/10.1007/s004310050552
PMid:9007492
 
13. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European consensus guidelines on the management of respiratory distress syndrome-2016 update. Neonatology. 2017;111(2):107-25.
https://doi.org/10.1159/000448985
PMid:27649091
 
14. Halliday HL, Ehrenkranz RA, Doyle LW. Moderately early (7‐14 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2003;1:CD001144.
https://doi.org/10.1002/14651858.CD001144
 
15. Halliday HL. Clinical trials of postnatal corticosteroids: inhaled and systemic. Biol Neonate. 1999;76(Suppl 1):29-40.
https://doi.org/10.1159/000047044
PMid:10393391
 
16. Halliday H, Ehrenkranz R, Doyle L. Early postnatal (<96 hours) corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2003;1:CD001146.
https://doi.org/10.1002/14651858.CD001146
 
17. Halliday HL, Patterson CC, Halahakoon CW. A multicenter, randomized open study of early corticosteroid treatment (OSECT) in preterm infants with respiratory illness: comparison of early and late treatment and of dexamethasone and inhaled budesonide. Pediatrics. 2001;107(2):232-40.
https://doi.org/10.1542/peds.107.2.232
PMid:11158452
 
18. Doyle LW, Davis PG, Morley CJ, McPhee A, Carlin JB. Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: a multicenter, international, randomized, controlled trial. Pediatrics. 2006;117(1):75-83.
https://doi.org/10.1542/peds.2004-2843
PMid:16396863
Razavi International Journal of Medicine
Volume 7, Issue 3.4
July 2019
Pages 28-33

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