Adjunctive pharmacotherapy in neonates with respiratory failure

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Summary

Whereas oxygen, continuous positive airway pressure (CPAP) and mechanical ventilation are the mainstays of treatment of pulmonary conditions in newborns, there are a number of adjunctive therapies that may improve the pulmonary function of these infants. These include the use of bronchodilators and diuretics given either systemically or through the inhaled route, mucolytic agents, and anti-inflammatory agents. This chapter gives an overview of the use of the most-studied agents including aerosolized bronchodilators, systemic and inhaled diuretics, and systemic and inhaled corticosteroids in the treatment and prevention of, where appropriate, respiratory distress syndrome, bronchopulmonary dysplasia, and meconium aspiration syndrome. Evidence on the use of mucolytic agents including acetylcysteine and deoxyribonuclease, and the anti-inflammatory agents including the macrolide antibiotics, cromolyn, pentoxyfylline, and recombinant human Clara cell protein are also reviewed.

Section snippets

Aerosolised bronchodilators

Aerosolised medications are able to achieve high topical concentrations within the respiratory tract without unwanted high systemic concentrations and resultant side-effects. Devices that are available for the delivery of aerosolised medications to neonates and infants include the nebulisers (jet and ultrasonic), and the metered dose inhalers (MDI). Among these devices, the ultrasonic nebuliser and the MDI used together with a spacer are more efficient than the jet nebuliser in delivering

Systemic diuretics

Infants with acute respiratory disease and early stage of BPD are often complicated by pulmonary alveolar and interstitial oedema resulting from increased pulmonary capillary permeability, increase in pulmonary blood flow secondary to patent ductus arteriosus (PDA), and fluid overload.4, 20 The presence of pulmonary oedema will further decrease the already jeopardised lung functions of the infants by reducing lung compliance and increasing airway resistance.4 Diuretic therapy theoretically may

Acetylcysteine

Acetylcysteine is a mucolytic agent used commonly for the treatment of adults and children with respiratory conditions associated with thick mucus formation such as cystic fibrosis, bronchitis and bronchiectasis. The mucolytic action of acetylcysteine is related to the sulfhydryl group in its molecule which reduces the viscosity of mucus by splitting the disulphide bonds linking the mucoproteins, the major constituent of mucus. Acetylcysteine is also a potent antioxidant, being a precursor of

Anti-inflammatory agents in meconium aspiration syndrome and evolving bronchopulmonary dysplasia

In both MAS and BPD, inflammation plays an important role in the pathogenesis of lung injury. A number of anti-inflammatory agents have been investigated for their therapeutic values in BPD and/or MAS. These include corticosteroids, cromolyn, the macrolide antibiotics, pentoxifylline, and the experimental agent Clara cell protein.

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