Skip to main content
PMC home page
Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 1994 May;70(3):F218–F222. doi: 10.1136/fn.70.3.f218

Bronchodilator aerosol administered by metered dose inhaler and spacer in subacute neonatal respiratory distress syndrome.

H Lee 1, S Arnon 1, M Silverman 1
PMCID: PMC1061045  PMID: 8198418

Abstract

There is increasing evidence that bronchodilators are effective in ventilator dependent preterm infants. The effects of single doses of salbutamol (400 micrograms), ipratropium bromide (72 micrograms), and placebo (four puffs) given by metered dose inhaler and spacer (MDIS) were examined in 10 ventilated preterm infants, with a mean birth weight of 800 g at a postnatal age of 1 week, who were suffering from respiratory distress syndrome. The agents were each given in an open, random design. Blood gases were measured and ventilatory efficiency index (VEI) and arterial/alveolar oxygen tension ratio (PaO2/PAO2) were calculated five minutes before and 30 minutes after administration. Heart rate and mean arterial blood pressure were noted. The mean PaO2 improved by 0.61 kPa and 0.69 kPa after salbutamol and ipratropium bromide, respectively and these changes were significantly greater than the 0.5 kPa fall seen with placebo. The mean arterial carbon dioxide tension fell by 0.98 kPa after salbutamol and 0.59 kPa after ipratropium bromide. After both salbutamol and ipratropium bromide, VEI improved significantly (by 23% and 20% respectively) but there was no significant change in the PaO2/PAO2, suggesting that respiratory mechanics and not ventilation/perfusion balance had improved after a single dose of bronchodilator. We conclude that both salbutamol and ipratropium bromide given by MDIS have useful short term effects in ventilator dependent neonates with respiratory distress syndrome. Precise dose regimens and long term effects remain to be worked out.

Full text

PDF
F218

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahrens R. C., Ries R. A., Popendorf W., Wiese J. A. The delivery of therapeutic aerosols through endotracheal tubes. Pediatr Pulmonol. 1986 Jan-Feb;2(1):19–26. doi: 10.1002/ppul.1950020108. [DOI] [PubMed] [Google Scholar]
  2. Arnon S., Grigg J., Nikander K., Silverman M. Delivery of micronized budesonide suspension by metered dose inhaler and jet nebulizer into a neonatal ventilator circuit. Pediatr Pulmonol. 1992 Jul;13(3):172–175. doi: 10.1002/ppul.1950130309. [DOI] [PubMed] [Google Scholar]
  3. Banerjee C. K., Girling D. J., Wigglesworth J. S. Pulmonary fibroplasia in newborn babies treated with oxygen and artificial ventilation. Arch Dis Child. 1972 Aug;47(254):509–518. doi: 10.1136/adc.47.254.509. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Barnes P. J., Basbaum C. B., Nadel J. A. Autoradiographic localization of autonomic receptors in airway smooth muscle. Marked differences between large and small airways. Am Rev Respir Dis. 1983 Jun;127(6):758–762. doi: 10.1164/arrd.1983.127.6.758. [DOI] [PubMed] [Google Scholar]
  5. Bhutani V. K., Koslo R. J., Shaffer T. H. The effect of tracheal smooth muscle tone on neonatal airway collapsibility. Pediatr Res. 1986 Jun;20(6):492–495. doi: 10.1203/00006450-198606000-00002. [DOI] [PubMed] [Google Scholar]
  6. Brundage K. L., Mohsini K. G., Froese A. B., Fisher J. T. Bronchodilator response to ipratropium bromide in infants with bronchopulmonary dysplasia. Am Rev Respir Dis. 1990 Nov;142(5):1137–1142. doi: 10.1164/ajrccm/142.5.1137. [DOI] [PubMed] [Google Scholar]
  7. Cabal L. A., Larrazabal C., Ramanathan R., Durand M., Lewis D., Siassi B., Hodgman J. Effects of metaproterenol on pulmonary mechanics, oxygenation, and ventilation in infants with chronic lung disease. J Pediatr. 1987 Jan;110(1):116–119. doi: 10.1016/s0022-3476(87)80302-5. [DOI] [PubMed] [Google Scholar]
  8. Cameron D., Arnot R., Clay M., Silverman M. Aerosol delivery in neonatal ventilator circuits: a rabbit lung model. Pediatr Pulmonol. 1991;10(3):208–213. doi: 10.1002/ppul.1950100314. [DOI] [PubMed] [Google Scholar]
  9. Carstairs J. R., Nimmo A. J., Barnes P. J. Autoradiographic visualization of beta-adrenoceptor subtypes in human lung. Am Rev Respir Dis. 1985 Sep;132(3):541–547. doi: 10.1164/arrd.1985.132.3.541. [DOI] [PubMed] [Google Scholar]
  10. Denjean A., Guimaraes H., Migdal M., Miramand J. L., Dehan M., Gaultier C. Dose-related bronchodilator response to aerosolized salbutamol (albuterol) in ventilator-dependent premature infants. J Pediatr. 1992 Jun;120(6):974–979. doi: 10.1016/s0022-3476(05)81973-0. [DOI] [PubMed] [Google Scholar]
  11. Grigg J., Arnon S., Jones T., Clarke A., Silverman M. Delivery of therapeutic aerosols to intubated babies. Arch Dis Child. 1992 Jan;67(1 Spec No):25–30. doi: 10.1136/adc.67.1_spec_no.25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hislop A. A., Haworth S. G. Airway size and structure in the normal fetal and infant lung and the effect of premature delivery and artificial ventilation. Am Rev Respir Dis. 1989 Dec;140(6):1717–1726. doi: 10.1164/ajrccm/140.6.1717. [DOI] [PubMed] [Google Scholar]
  13. Kao L. C., Warburton D., Platzker A. C., Keens T. G. Effect of isoproterenol inhalation on airway resistance in chronic bronchopulmonary dysplasia. Pediatrics. 1984 Apr;73(4):509–514. [PubMed] [Google Scholar]
  14. Kwong M. S., Egan E. A., Notter R. H., Shapiro D. L. Double-blind clinical trial of calf lung surfactant extract for the prevention of hyaline membrane disease in extremely premature infants. Pediatrics. 1985 Oct;76(4):585–592. [PubMed] [Google Scholar]
  15. O'Brodovich H. M., Mellins R. B. Bronchopulmonary dysplasia. Unresolved neonatal acute lung injury. Am Rev Respir Dis. 1985 Sep;132(3):694–709. doi: 10.1164/arrd.1985.132.3.694. [DOI] [PubMed] [Google Scholar]
  16. Phipps P. R., Gonda I. Droplets produced by medical nebulizers. Some factors affecting their size and solute concentration. Chest. 1990 Jun;97(6):1327–1332. doi: 10.1378/chest.97.6.1327. [DOI] [PubMed] [Google Scholar]
  17. Rosan R. C. Hyaline membrane disease and a related spectrum of neonatal pneumopathies. Perspect Pediatr Pathol. 1975;2:15–60. [PubMed] [Google Scholar]
  18. Rotschild A., Solimano A., Puterman M., Smyth J., Sharma A., Albersheim S. Increased compliance in response to salbutamol in premature infants with developing bronchopulmonary dysplasia. J Pediatr. 1989 Dec;115(6):984–991. doi: 10.1016/s0022-3476(89)80755-3. [DOI] [PubMed] [Google Scholar]
  19. Silverman M. Aerosol therapy in the newborn. Arch Dis Child. 1990 Aug;65(8):906–908. doi: 10.1136/adc.65.8.906. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Taghizadeh A., Reynolds E. O. Pathogenesis of bronchopulmonary dysplasia following hyaline membrane disease. Am J Pathol. 1976 Feb;82(2):241–264. [PMC free article] [PubMed] [Google Scholar]
  21. Wilkie R. A., Bryan M. H. Effect of bronchodilators on airway resistance in ventilator-dependent neonates with chronic lung disease. J Pediatr. 1987 Aug;111(2):278–282. doi: 10.1016/s0022-3476(87)80087-2. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood Fetal and Neonatal edition are provided here courtesy of BMJ Publishing Group

RESOURCES