Pilot Study of Topical Steroid for Prevention of Chronic Lung Disease in Extremely Premature Infants.

• To measure the effect of surfactant with and without Budesonide on the development of BPD in ELBW infants. [ Time Frame: Supplemental oxygen requirement at 36 weeks' postmenstrual age (PMA) ] [ Designated as safety issue: No ]
  The main goal of the study is to determine whether endotracheal instillation of surfactant (Infasurf) with or without potent topical steroid (Budesonide) reduces the development of Bronchopulmonary Dysplasia (BPD) in Extremely Low Birth Weight (ELBW) infants at high risk of BPD.
  
  

• To measure the effect of surfactant with and without Budesonide on the inflammatory cytokines in tracheal aspirates. [ Time Frame: The measurement of cytokines in tracheal aspirate samples will be done at the end of the study. ] [ Designated as safety issue: No ]
  Tracheal aspirate samples will be collected before instillation of each dose of the study drug, 7 days after the last dose if the infant is still intubated, and prior to elective extubation regardless of when extubation occurs. Tracheal aspirate samples will be obtained from the control (standard management) group in the same way and using the same time frame as the treatment groups
  
  

Bronchopulmonary Dysplasia (BPD) is still one of the most common complications of ventilated premature infants. Lung inflammation plays a major role in its pathogenesis. Systemic steroids can be given to control this inflammatory process but their widespread use is limited by their systemic side effects and concerns for long neurodevelopmental adverse sequelae. Delivering steroids by inhalation which has been proven to be effective in young infants with asthma has been shown to be unsatisfactory for ELBW infants with BPD. This may be due to the fact that current delivery devices do not meet the requirements of the specific anatomical and physiologic characteristics of the airways and breathing patterns in this special group of patients. A novel approach to facilitate delivery directly to the lungs, thereby avoiding systemic concerns has been demonstrated in a recent study in which budesonide ( a topical steroid) was given to ventilated preterm infants using surfactant as a vehicle.