We have previously reported that IV steroid reduces the severity of bronchopulmonary dysplasia in very-low birthweight (VLBW) infants (NEJM 1989; 320:1505). However, adverse effects have been reported. The INH route may maximize pulmonary effects while minimizing systemic effects but there have been no studies comparing INH to IV steroids. We are therefore comparing these two routes in preterm (≤ 30 weeks), VLBW (≤1500 grams) infants who are both ventilator (IMV ≥ 15) and oxygen (FiO2 ≥ 0.3) dependent at 12-21 d of age. From July 10, 1994 to December 1, 1995, 55 infants have been randomized to receive either a 42-day tapering course of IV dexamethasone(n=17), or one of two doses (400 μg daily, n=17; 800 μg daily, n=21) of INH beclomethasone. Baseline FiO2, ventilatory pressure (PIP-PEEP), and mean blood pressure were similar between groups. Baseline mean airway pressure was higher in the IV group, in which two infants required high frequency ventilation. Changes in airway pressures (cm H2O) and blood pressure(mm Hg) are shown below (data from the two INH groups are combined since results were similar): Table

Table 1
Full size table

Two infants in the IV group were treated briefly for hypertension. Durations of mechanical ventilation, supplemental oxygen, and hospital stay did not differ between the groups. The incidences of gastrotinestinal bleeding, hyperglycemia, sepsis and/or necrotizing enterocolitis, and retinopathy were also similar.

While acute improvement in lung mechanics may be more dramatic in infants receiving IV steroid, there were no differences in long-term efficacy or incidences of side effects.