Adjunctive pharmacotherapy in neonates with respiratory failure
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.
References (103)
- et al.
Dose-related bronchodilator response to aerosolized salbutamol (albuterol) in ventilator-dependent premature infants
J Pediatr
(1992) - et al.
Effects of metaproterenol on pulmonary mechanics, oxygenation, and ventilation in infants with chronic lung disease
J Pediatr
(1987) - et al.
Effect of bronchodilators on airway resistance in ventilator-dependent neonates with chronic lung disease
J Pediatr
(1987) - et al.
Increased compliance in response to salbutamol in premature infants with developing bronchopulmonary dysplasia
J Pediatr
(1989) Bronchoalveolar inflammatory pathophysiology of bronchopulmonary dysplasia
Clin Perinatol
(1995)- et al.
Furosemide acutely decreases airways resistance in chronic bronchopulmonary dysplasia
J Pediatr
(1983) - et al.
Short- and long-term effects of furosemide on lung function in infants with bronchopulmonary dysplasia
J Pediatr
(1986) - et al.
Pulmonary effects of furosemide in preterm infants with lung disease
J Pediatr
(1983) - et al.
Role of furosemide therapy after booster-packed erythrocyte transfusions in infants with bronchopulmonary dysplasia
J Pediatr
(1990) - et al.
Double-blind, placebo-controlled trial of alternate-day furosemide in infants with chronin bronchopulmonary dysplasia
J Pediatr
(1990)
Controlled trial of furosemide therapy in infants with chronic lung disease
J Pediatr
Addition of metolazone to overcome tolerance to furosemide in infants with bronchopulmonary dysplasia
J Pediatr
Calcium transport through the luminal membrane of the distal tubule. I. Interrelationship with sodium
Kidney Int
Oral theophylline and diuretics improve pulmonary mechanics in infants with bronchopulmonary dysplasia
J Pediatr
Randomized, double-blind, controlled trial of long-term diuretic therapy for bronchopulmonary dysplasia
J Pediatr
Randomized trial of long-term diuretic therapy for infants with oxygen-dependent bronchopulmonary dysplasia
J Pediatr
Nebulized furosemide in infants with bronchopulmonary dysplasia
J Pediatr
N-acetylcysteine does not prevent bronchopulmonary dysplasia in immature infants: a randomized controlled trial
J Pediatr
Inflammatory markers in meconium induced lung injury in neonates and effect of steroids on their levels: a randomized controlled trial
Indian J Med Microbiol
Inhibition of phagocyte chemotaxis by uteroglobin, an inhibitor of blastocyst rejection
Biochem Pharmacol
Delivery of salbutamol to nonventilated preterm infants by metered-dose inhaler, jet nebulizer, and ultrasonic nebulizer
Eur Respir J
Efficiency of aerosol medication delivery from a metered dose inhaler versus jet nebulizer in infants with bronchopulmonary dysplasia
Pediatr Pulmonol
Delivery of therapeutic aerosols to intubated infants
Arch Dis Child
Pulmonary disease following respiratory therapy of hyaline-membrane disease. Bronchopulmonary dysplasia
N Engl J Med
A new baby-spacer device for aerosolized bronchodilator administration in infants with bronchopulmonary dysplasia
Eur J Pediatr
Effect of isoproterenol inhalation on airway resistance in chronic bronchopulmonary dysplasia
Pediatrics
Early onset airway reactivity in premature infants with bronchopulmonary dysplasia
Am Rev Respir Dis
Effects of inhaled metaproterenol and atropine on the pulmonary mechanics of infants with bronchopulmonary dysplasia
Pediatr Pulmonol
Randomised crossover trial of salbutamol aerosol delivered by metered dose inhaler, jet nebuliser, and ultrasonic nebuliser in chronic lung disease
Arch Dis Child Fetal Neonatal Ed
Effective bronchodilator treatment by a simple spacer device for wheezy premature infants
Arch Dis Child
Respiratory response to salbutamol (albuterol) in ventilator- dependent infants with chronic lung disease: pressurized aerosol delivery versus intravenous injection
Intensive Care Med
Bronchodilator aerosol administered by metered dose inhaler and spacer in subacute neonatal respiratory distress syndrome
Arch Dis Child
Bronchodilator response to ipratropium bromide in infants with bronchopulmonary dysplasia
Am Rev Respir Dis
Inhaled salbutamol and beclomethasone for preventing broncho-pulmonary dysplasia: a randomised double-blind study
Eur J Pediatr
Bronchodilators for the prevention and treatment of chronic lung disease in preterm infants
Cochrane Database Syst Rev
Decreased pulmonary transvascular fluid filtration in awake newborn lambs after intravenous furosemide
J Clin Invest
Drug therapy for bronchopulmonary dysplasia
Pediatr Pulmonol
Furosemide promotes patent ductus arteriosus in premature infants with respiratory-distress syndrome
N Engl J Med
Diuretics for respiratory distress syndrome in preterm infants
Cochrane Database Syst Rev
Pulmonary and renal responses to furosemide in infants with stage III–IV bronchopulmonary dysplasia
Am J Dis Child
Bronchodilators and diuretics in children with bronchopulmonary dysplasia
Pediatr Pulmonol
Intravenous or enteral loop diuretics for preterm infants with (or developing) chronic lung disease
Cochrane Database Syst Rev
Renal calcifications: a complication of long-term furosemide therapy in preterm infants
Pediatrics
Effect of diuretics on urinary oxalate, calcium, and sodium excretion in very low birth weight infants
Pediatrics
Effect of oral diuretics on pulmonary mechanics in infants with chronic bronchopulmonary dysplasia: results of a double-blind crossover sequential trial
Pediatrics
Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease
Cochrane Database Syst Rev
Renal and extrarenal hemodynamic effects of furosemide in congestive heart failure after acute myocardial infarction
N Engl J Med
Furosemide-induced airway relaxation in guinea pigs: relation to Na-K-2Cl cotransporter function
Am J Phys
Loop diuretics inhibit cholinergic and noncholinergic nerves in guinea pig airways
Am Rev Respir Dis
Furosemide-induced bronchodilation in the rat bronchus: evidence of a role for prostaglandins
Lung
Cited by (21)
Pharmacologic therapies
2022, Goldsmith's Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care, Seventh EditionProtective action of N-acetyl-L-cysteine associated with a polyvalent antivenom on the envenomation induced by Lachesis muta muta (South American bushmaster) in rats
2021, ToxiconCitation Excerpt :In this study, we aimed to investigate the potential use of N-acetyl-L-cysteine (NAC), a drug known for scavenging a wide variety of reactive oxygen species (ROS) and increasing the intracellular level of glutathione (Briguori et al., 2011; Nicoletta et al., 2006; Paller and Patten, 1984; Thielemann and Rosenblut, 1990), to reduce the local and systemic effects induced by L. m. muta venom in rats. NAC is rapidly distributed and is free of systemic toxicity, being used therapeutically in the treatment of respiratory disorders (Fok, 2009; El-Hafiz et al., 2013; Moroz et al., 2019; Rogliani et al., 2019; Zhang et al., 2017). In recent studies, NAC has also demonstrated to be effective at inhibiting the haemorrhagic and nephrotoxic activities induced by Viperidae snakes from the New (Barone et al., 2014) and Old World (Sunitha et al., 2011, 2013).
Pharmacologic Therapies IV: Other Medications
2017, Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care: Sixth EditionEffects of N-acetyl-l-cysteine on redox status and markers of renal function in mice inoculated with Bothrops jararaca and Crotalus durissus terrificus venoms
2014, ToxiconCitation Excerpt :Some drugs previously suggested as appropriated to treat renal dysfunction caused by the venoms of Bothrops jararaca (vBj) and Crotalus durissus terrificus (vCdt) are antioxidants also able to change aminopeptidase (AP) activities in renal tissue of mice (Alegre et al., 2010; Barone et al., 2011; Frezzatti and Silveira, 2011; Yamasaki et al., 2008). N-acetyl-l-cysteine (NAC) is a thiol antioxidant reported to have few collateral effects (Fok, 2009). NAC is usually recommended for respiratory dysfunction and prophylaxis against radiographic contrast-induced nephropathy, since acts as a mucolytic drug.
The premature infant with chronic lung disease/bronchopulmonary dysplasia: Follow-up
2011, Anales de Pediatria ContinuadaAcute lung injury in preterm newborn infants: Mechanisms and management
2010, Paediatric Respiratory ReviewsCitation Excerpt :Meta-analysis of clinical trials using diuretics which act on both the proximal and distal renal tubules have demonstrated an improvement in short-term pulmonary mechanics when used in preterm infants >3 weeks of age. However, because these trials did not include clinical outcomes such as oxygen dependency or long-term follow-up data, there is lack of evidence for the use of these drugs in preventing or treating lung injury in preterm infants.58 Physiologically, a PDA can have the same effect on pulmonary mechanics as water overloading.