Steroid Treatment Fails to Prevent Lung Disease in Preemies: What Now?
A recent clinical trial has shaken the medical community’s approach to treating lung disease in preterm infants. The study, published in JAMA, reveals that intratracheal steroids, when combined with surfactant therapy, do not reduce the risk of lung disease or mortality in extremely premature babies. This finding contradicts earlier, smaller studies, leaving researchers with more questions than answers.
According. to Dr. Marta Perez, a neonatal expert and co-author of the study, Bronchopulmonary dysplasia (BPD) is a chronic respiratory condition that frequently affects preterm infants. Despite advancements in neonatal care, BPD rates remain high. The research team aimed to build on previous studies that suggested adding the anti-inflammatory drug budesonide to surfactant therapy could reduce BPD risk.
The multicenter trial involved 641 infants born extremely prematurely, who were given surfactant therapy within 50 hours of birth. Half of the infants also received budesonide. But here’s where it gets controversial: the trial was stopped early due to a lack of significant improvement. Both groups showed almost identical rates of BPD or death by 36 weeks, with a mere 0.6% difference.
This finding contradicts previous beliefs and raises questions. Earlier trials had indicated a potential benefit of combining budesonide and surfactant, but the recent study’s authors argue that those trials were smaller and less rigorous. So, what’s next for these vulnerable infants?
Dr. Perez and her team are now exploring whether intratracheal steroids could benefit preterm babies with specific conditions, such as lung inflammation or genetic predispositions. And this is the part most people miss: while surfactant therapy is a vital component of neonatal care, the quest for additional treatments to combat chronic lung disease in preemies continues. The field of neonatology still has many unanswered questions, and researchers must persist in their efforts to find solutions.
The study was supported by prominent institutions, including the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, highlighting the importance of this research.