Abstract 1047 Neonatology: Clinical Studies in the Premature Infant Platform, Tuesday, 5/4

Despite recent advances in respiratory care of newborn infants, tracheobroncheal mucosal injury continues to be a significant complication of mechanical ventilation. To evaluate the effect of inhaled steroid treatment on tracheobronchial mucosal injury, limited bronchoscopy was performed on infants who were participating in a multicenter randomized placebo-controlled, double-blind clinical trial of early administration of beclomethasone (40ug/kg/day, tapered over 4 weeks) or placebo given by a metered dose inhaler and aerochamber® (Monagahan Medical Group Corp, Inc.). These infants were <33 weeks GA and <1251 gm BW and required assisted ventilation between day 3-14 of life. Infants who received systemic steroids were excluded.

Bronchoscopy was performed before, one and two weeks after treatment, with a Flexible Olympus Scope 2.2mm outer diameter, 2.8cm directable tip of 130° flexion and 65° anti-flexion and no suction channel, through an adaptor attached to the ET tube while infant was on mechanical ventilation. Mucosal changes were classified by a visual scoring system based on hyperemia, edema, hemorrhage, ulceration and granulation. A score of 0-2 was given to each variable with total score of 0 to 10 (1.3 = Mild, 4-7 = Moderate, and 8-10 = Severe). Inhaled steroid (n=17) and placebo group (n=19) had similar BW (751±184 vs. 819±200g SD), and GA (26.5±1.8 vs. 26.8±1.7 wks SD).

Pre-treatment mucosal findings for inhaled steroid as compared to placebo were: hyperemia 93% vs. 89%, edema 62% vs. 31%, hemorrhage 31% vs. 37%, ulceration 12% vs. 16%, and granulation 6% vs. 5%. Steroid and placebo groups had similar injury scores (2.6 ±1.6 vs. 3.0±2.5 SD).

One week after treatment, mucosal findings of steroid group as compared to placebo were: hyperemia 94% vs. 94.2%, edema 25% vs. 71%, hemorrhage 19% vs. 41%, ulceration 0% vs. 0%, and granulation 25% vs. 29%. This difference of score 1.9±1.2 vs. 3.3±3.0 was significant (P<.02). Two weeks after treatment severe changes with granulation tissue were present in 33% placebo group (N=9) and 0% in inhaled steroid group (N=10). Summary: Early Rx with inhaled beclomethasone appears to be effective in resolving and preventing further tracheobronchial mucosal injury.