437 - Intratracheal instillation of budesonide-surfactant for prevention of bronchopulmonary dysplasia in extremely premature infants

Poster Number: 437
Publication Number: 437.430

Aayushka Gurung, University of South Alabama Children's and Women's Hospital, Mobile, AL, United States; Michael Zayek, University of South Alabama College of Medicine, Mobile, AL, United States; Fabien Eyal, University of South Alabama, Mobile, AL, United States; Kalsang Dolma, University of South Alabama, Mobile, AL, United States

Background: Bronchopulmonary dysplasia (BPD) is one of the common causes of morbidity among extremely preterm (EP) infants. While systemic corticosteroid therapy after the first week of life has been successful in reducing death or BPD, it has also been associated with short- and long-term adverse effects. Recent studies have indicated the beneficial role of intratracheal administration of budesonide in decreasing BPD or death, a therapy that may dampen lung inflammation at an earlier stage without systemic undesirable complications.

Objective: To determine the effect of intratracheal instillation of budesonide-surfactant on the incidence of BPD or death as compared with surfactant alone.

Design/Methods: In this retrospective, single center study, we included 1033 EP infants with a gestational age (GA) of ≤ 28 weeks, who were born between January 2010 and December 2020 and received surfactant therapy. At our institution, budesonide was added to all surfactant suspensions prior to intratracheal instillation since February 2016. Neonates who received budesonide-surfactant combination (Pulmicort group, n=314) were compared with surfactant alone (control group, n=719). The primary outcome was a composite of grade 2/3 BPD (defined as in Jensen et al; 2019) or death before 36 weeks postmenstrual age (PMA). In the analysis of all outcomes, the results were adjusted for known risk factors of BPD.

Results: The rate of grade 2/3 BPD or death before 36 weeks PMA did not differ between the Pulmicort group and the control group (66.6% and 55.2% respectively, adjusted relative risk (RR) with the Pulmicort group is 1.046; 95 % confidence interval [CI] 0.907 to 1.177; P=0.515). Death before 36 weeks PMA did not differ between the two groups (13.1 % vs 12.7%; RR 0.791; 95 % CI 0.523 -1.174; P=0.25). There were no significant differences between the two groups in the rates of BPD grade 2/3 (61.5% vs 48.7%; RR 1.094; 95 % CI 0.932-1.253; P=0.253), systemic hydrocortisone use, retinopathy of prematurity requiring treatment, intraventricular hemorrhage grade 3 or 4, necrotizing enterocolitis, spontaneous intestinal perforation, or sepsis.Conclusion(s): In EP infants, budesonide therapy is not beneficial in decreasing combined outcome of BPD grade 2/3 or death. Further trials are needed.
CVMy_CV-2.pdf
Primary and secondary outcomes (adjusted for gestational age, birthweight, outborn, doses of surfactant, delivery room intubation, culture positive sepsis, NEC, SIP, and hemodynamically significant PDA)