Background: BPD is a chronic lung disease often occuring in ventilator treated VLBW infants. Several studies demonstrate the role of pro-inflammatory cytokines and their reduction after corticosteroid treatment. Because of adverse effects of dexamethasone, we tried a new therapeutic approach using ACTH, that seems to imply less severe side effects.Aim: To compare the antiinflammatory action and side effects of ACTH and dexamethasone in VLBW infants by measuring IL6 and a-MSH, known as an endogenous anti-inflammatory agent. Population: We enrolled 14 VLBW infants, mean GA 29.2 wks (range 26-32 wks) and mean BW 1135 g (range 570-1810), mechanically ventilated for RDS. At 6th day of life neonates were randomized into 2 groups: group A (n=7) received dexamethasone (0.5mg/kg per day for 3 days) and group B (n=7) received ACTH (Synacthen 150 mcg/m2 per day for 3 days). The 2 groups had similar clinical characteristics before treatment (GA, BW, OI, AaDO2) (p=NS). Blood levels of IL6 and a-MSH were evaluated in 1st, 3rd, 6th, 10th and 15th day of life. Results: IL6 maximum levels were observed on the 1st day of life in group A (67.68±71.6 pg/ml) and on the 3rd day of life in group B (53.17±82 pg/ml). On the 10th day of life IL-6 reached minimum levels in both groups(A:10.82±18.1 pg/ml; B:5.94±5.9 pg/ml), while a-MSH reached maximum levels (A: 26.38±10.8 pg/ml; B:22.71±5.4 pg/ml). Both groups showed a significant (p<0.05) but transient rise of blood pressure; hyperglycemia and myocardial hypertrophy were not observed. BPD occurred in 3 infants in both groups.
Discussion: Our data indicate that blood levels of IL6 are markedly increased on 1st day of life and start to decrease spontaneously on the 3rd day of life when a-MSH shows an increasing trend suggesting that anti-inflammatory therapy should start earlier than the 6th day of life. In addition, a-MSH seems to have a role in the anti-inflammatory endogenous reaction. Finally, the observation of a similar clinical outcome in the 2 groups in terms of development of BPD, suggests the possibility of using ACTH as an alternative treatment to dexamethasone.
Author information
Authors and Affiliations
Additional information
(Spon by: FABIO SERENI)
Rights and permissions
About this article
Cite this article
Mosca, F., Catania, A., Colnaghi, M. et al. Randomized Trial ACTH vs Dexamethasone In Mechanically Ventilated VLBW Infants 1707. Pediatr Res 43 (Suppl 4), 291 (1998). https://doi.org/10.1203/00006450-199804001-01729
Issue Date:
DOI: https://doi.org/10.1203/00006450-199804001-01729