Comparison of the Efficacy of Intratracheal Instillation of Surfactant With and Without Budesonide

Vijayalaxmi Budihal, Vinayak Yadavrao Kshirsagar, Rajsinh Vishwasrao Mohite

Abstract

Aim: To determine whether intratracheal instillation of surfactant with budesonide would improve pulmonary status (ie, oxygenation days, ventilator dependency, and duration of NICU stay) in preterm neonates

Materials and Methods: A randomized trial was conducted at a tertiary care hospital in 60 preterm neonates who had severe respiratory distress syndrome (RDS) and required oxygen support soon after birth. The 30 neonates in the study group received 5 mg/kg of Neosurf (a surfactant) and 0.5 mg/kg of budesonide (a corticosteroid) through intratracheal instillation, while the 30 neonates in the control group received 5 mg/kg Neosurf only. Both the groups were followed up for the end point assessment regarding improvement in pulmonary status.

Results: The study group required significantly lesser oxygenation days (3.56 ± 3.29 d vs 3.86 ± 3.12 d), had lesser ventilator dependency (17 of 30 [28.2%] vs 26 of 30 [43.7%]; P = .03), and shorter NICU stay (11.89 ± 7.16 d vs 16.0 ± 7.99 d; P = .040) compared with the control group. No clinically significant adverse effects were observed during the study.

Conclusions: In preterm neonates with severe RDS, intratracheal instillation of surfactant with budesonide compared with surfactant alone significantly reduced the need for mechanical ventilation and decreased the duration of NICU stay and days of oxygen dependency, without adverse effects.