Abstract
Objective This study aimed to determine the effect of intratracheal instillation of a budesonide–surfactant
combination on the incidence of bronchopulmonary dysplasia (BPD) or death compared
with surfactant alone in extremely preterm infants.
Study Design In this retrospective, single-center study, we included extremely preterm infants
(<28 weeks' gestation) who received surfactant for respiratory distress in the first
3 days of life. We compared infants who received budesonide–surfactant combination
(intervention group: infants born between February 2016 and October 2021) with surfactant
alone (control group: infants born from January 2010 through January 2016). The primary
outcome was a composite of BPD grade 2 or 3 (as defined by Jensen et al, 2019) or
death before 36 weeks' postmenstrual age (PMA).
Results We included 966 extremely preterm infants (528 in the control group and 438 in the
intervention group). While the incidence of death/BPD grade 2 or 3 at 36 weeks of
PMA was not different between the two groups (66% in the intervention group vs. 63%
in the control group; adjusted relative risk [aRR], 0.99; 95% confidence interval
[CI], 0.90–1.07; p-value = 0.69), budesonide was associated with a reduction in the primary outcome
only in a subgroup of infants with birth weight ≥ 750 grams (36.8 vs. 43.5%, respectively;
aRR 0.75; 95% CI, 0.57–0.98). Primary and secondary outcomes did not differ between
the two groups within the subgroup of infants weighing <750 grams.
Conclusion In extremely preterm infants, the budesonide–surfactant combination therapy reduced
the rates of BPD or death in infants weighing ≥750 grams; however, this beneficial
effect was not seen in infants weighing <750 grams. Further investigation of this
treatment may be indicated before it is considered a standard approach to management.
Key Points
-
Intratracheal budesonide–surfactant therapy reduces BPD in preterm infants weighing
≥750 grams.
-
Intratracheal budesonide–surfactant therapy does not affect BPD in preterm infants
weighing <750 grams.
-
Intratracheal budesonide–surfactant therapy does not affect the mortality rate in
preterm infants.
Keywords
surfactant - intratracheal budesonide - corticosteroid - bronchopulmonary dysplasia
- extremely preterm infants
