(8) Effectiveness of Intratracheal Surfactant and Budesonide for Prevention of Bronchopulmonary Dysplasia

Background: Bronchopulmonary dysplasia (BPD) is a common sequalae among infants born prematurely. Incidence of BPD has increased over the last decade despite the advances in neonatal care. Intratracheal surfactant mixed with budesonide (SB) is a novel therapy that has shown promising results in development of BPD by decreasing lung inflammation. There is limited data on the effectiveness of SB outside of clinical trials.

Objectives: To evaluate the effectiveness of SB in preventing BPD or death.

Design/Methods: We included all preterm infants < 32 weeks gestational age hospitalized in St. Mary’s Hospital neonatal intensive care unit (NICU) in Madison, WI who received >1 dose of intratracheal surfactant. The cohort was divided into two groups, one group received only surfactant while the second group received SB. Exclusion criteria included infants with major congenital anomalies and death prior to admission to the NICU. In the surfactant only group, Poractant alfa was administered without Budesonide, and SB group, Poractant alfa was mixed with Budesonide 0.25 mg/kg. The primary outcome of BPD or death at 36 weeks post menstrual age was compared using univariate and multivariate analyses.

Results: A total of 144 infants were included in the study (75 in the surfactant group and 59 in the SB group). Gestational age and birth weight were lower in the SB group (Table 1). Incidence of death or BPD was higher in the SB group (61% vs 45%) on univariate testing. However, multivariate logistic analysis controlling for gestational age, birth weight, antenatal steroid status, and sex revealed no difference in death or BPD [aRR 1.08 (0.66, 1.76), p=0.753] between the two groups.

Conclusion: Our study reveals that there was no difference in the primary outcome of BPD or death after introduction of SB as a treatment strategy. Large clinical trials investigating efficacy of SB are currently underway. We suggest that NICUs should wait for results of these trials before adapting this strategy into clinical practice.