Brenda L. MacKinnon

Incidence of Hypertriglyceridemia in Critically Ill Neonates Receiving Lipid Injectable Emulsions in Glass Versus Plastic Containers: A Retrospective Analysis

OBJECTIVE To evaluate plasma clearance of lipid injectable emulsions packaged in either glass or plastic containers in neonates from 2 7-month periods, 1 year apart. STUDY DESIGN Clinical records from June 1 to December 31, 2003 (glass [G] period) and the same months in 2004 (plastic [P] period) were assessed. Neonates who received lipid injectable emulsions were studied. Lipid container (glass vs plastic) was the independent variable. RESULTS Of the 197 patients studied, 122 (G, 50/81; P, 72/116) had evaluable triglyceride (TG) levels, for an overall rate of 62%. Only birth weight (G, 1.09 +/- 0.32 kg vs P, 1.23 +/- .45 kg) and birth length (G, 36.4 +/- 3.5 cm vs P, 37.9 +/- 3.5 cm) were significantly different between the 2 groups (P = .047 and .028, respectively). There were no differences in the day of life on which lipid injection was started, the lipid dose, or the timing of TG measurements. The incidence of hypertriglyceridemia was significantly higher in the P period (G, 3/50 vs P, 19/72; P = .004). CONCLUSIONS Administration of the same lipid formulation in plastic bags compared with glass containers is associated with higher rates of hypertriglyceridemia. The poorer clearance of lipids could be due to a higher proportion of large-diameter fat globules in plastic bags compared with those in glass containers.

Early Inhaled Glucocorticoid Therapy to Prevent Bronchopulmonary Dysplasia

BACKGROUND The safety and efficacy of inhaled glucocorticoid therapy for asthma stimulated its use in infants to prevent bronchopulmonary dysplasia. We tested the hypothesis that early therapy with inhaled glucocorticoids would decrease the frequency of bronchopulmonary dysplasia in premature infants. METHODS We conducted a randomized, multicenter trial of inhaled beclomethasone or placebo in 253 infants, 3 to 14 days old, born before 33 weeks of gestation and weighing 1250 g or less at birth, who required ventilation therapy. Beclomethasone was delivered in a decreasing dosage, from 40 to 5 microg per kilogram of body weight per day, for four weeks. The primary outcome measure was bronchopulmonary dysplasia at 28 days of age. Secondary outcomes included bronchopulmonary dysplasia at 36 weeks of postmenstrual age, the need for systemic glucocorticoid therapy, the need for bronchodilator therapy, the duration of respiratory support, and death. RESULTS One hundred twenty-three infants received beclomethasone, and 130 received placebo. The frequency of bronchopulmonary dysplasia was similar in the two groups: 43 percent in the beclomethasone group and 45 percent in the placebo group at 28 days of age, and 18 percent in the beclomethasone group and 20 percent in the placebo group at 36 weeks of postmenstrual age. At 28 days of age, fewer infants in the beclomethasone group than in the placebo group were receiving systemic glucocorticoid therapy (relative risk, 0.6; 95 percent confidence interval, 0.4 to 1.0) and mechanical ventilation (relative risk, 0.8; 95 percent confidence interval, 0.6 to 1.0). CONCLUSIONS Early beclomethasone therapy did not prevent bronchopulmonary dysplasia but was associated with lower rates of use of systemic glucocorticoid therapy and mechanical ventilation.

Early Inhaled Glucocorticoid Therapy for Prevention of Neonatal Chronic Lung Disease |[bull]| 1629

Background: Systemic steroid therapy is widely used in treating infants at risk for chronic lung disease. Inhaled steroid therapy has potential advantages of direct delivery to the lung and fewer side effects.Methods:A multicenter, randomized, placebo-controlled, double-blind clinical trial was designed to test the hypothesis that early administration of inhaled beclomethasone would decrease the frequency of chronic lung disease with few systemic side effects. Infants <33 weeks gestation and <1251 grams birth weight still requiring assisted ventilation between days 3-14 of life were screened for enrollment. Infants were randomized to receive beclomethasone or placebo by metered dose inhaler and Aerochamber. Beclomethasone dose of 40 μg/kg/day was tapered over 4 weeks. Systemic steroid therapy was permitted if indicated. Outcome measures included frequency of chronic lung disease at age 28 days and at 36 weeks postconceptional age; death; frequency of systemic steroid therapy; duration of supplemental oxygen and mechanical ventilation. Occurrence of adverse effects, such as hyperglycemia, hypertension, infection, and decreased weight gain, were monitored. Results: 253 of 294 (86%) eligible infants were enrolled, randomized, and received either beclomethasone (n=123) or placebo (n=130). Baseline characteristics were similar between groups. Deaths by age 28 days: 7 beclomethasone v. 7 placebo. Deaths by 36 weeks postconceptional age: 11 beclomethasone v. 8 placebo. Among survivors, the study groups had similar frequency of chronic lung disease at age 28 days and 36 weeks postconceptional age. However, there was substantially less use of systemic steroid therapy in infants in the beclomethasone group v. placebo group at age 28 days and 36 weeks postconceptional age. The data also suggest that beclomethasone group had fewer days of supplemental oxygen and mechanical ventilation. There was no difference between groups with respect to death, systemic infection, blood glucose screens, blood pressures, weight gain, or ROP. Conclusion: Risk of chronic lung disease at age 28 days and 36 weeks postconceptional age was similar for infants treated with this regimen of early inhaled beclomethasone compared to placebo. Beclomethasone therapy resulted in less use of systemic steroid therapy. Increased used of systemic steroid therapy in the placebo group may have contributed to dampening detectable differences in chronic lung disease between the study groups.

INADEQUATE CORTISOL RESPONSE TO INSULIN INDUCED HYPOGLYCEMIA TEST (IIHT) IN PREMATURE INFANTS. † 1199

INADEQUATE CORTISOL RESPONSE TO INSULIN INDUCED HYPOGLYCEMIA TEST (IIHT) IN PREMATURE INFANTS. † 1199