Objective: To compare the effect of inhaled beclomethasone(BECLO), started at day 3 of life, and that of systemic dexamethasone (DEX), started between day 11- 13, on clinical variables and lung inflammation in preterm infants at risk for BPD.

Setting: Tertiary neonatal intensive care service.

Patients and Interventions: Preterm neonates with RDS, and with a birthweight less than 1200g were included into the pilot study, when they were still mechanically ventilated on day 3 of life. The patients (birthweight 826± 140 g, gestational age 26.1 ± 0.9 weeks, mean ±SD) were alternately allocated to a prophylactic treatment with inhaled BECLO (n=7), or to early DEX therapy, if clinically indicated (n=9).

Measurements: Pulmonary inflammation and permeability were assessed by analyzing the levels of interleukin-8, elastase-α1-proteinase inhibitor, free elastase activity, and albu-min in tracheal aspirate fluid. The secretory component for IgA served as reference protein.

Results: There were no differences in the concentrations of interleukin-8, elastase-α1-proteinase, and albumin between both groups during day 3 to day 10. However, on day 14 -three days following initiation of DEX treatment- concentrations of the inflammatory mediators and of albumin were markedly lower in the preterm infants treated with systemic DEX therapy when compared to infants treated with inhaled BECLO (p<0.05).

Conclusion: In contrast to systemic DEX treatment, inhaled BECLO failed to decrease pulmonary inflammation and microvascular permeability in preterm infants at risk for BPD.