Postnatal steroids in extreme preterm infants: Intra-tracheal instillation using surfactant as a vehicle

Chronic Lung Disease (CLD) is a common respiratory morbidity in survivors following extreme preterm birth, and is associated with adverse neurodevelopment in the long term. Besides demographics, multiple risk factors are implicated in the pathogenesis of CLD. However, early lung inflammation appears to be the common pathway that leads to the pathological and clinical changes observed in CLD. Postnatal use of systemic steroids has been successful in reducing the incidence of CLD but resulted in unacceptable adverse neurodevelopmental outcomes. The efficacy of inhaled steroids is not yet established. We review the evidence of tracheal instillation of steroids using surfactant as a lipid vehicle, including published data on drug distribution, in vitro physical studies, and clinical trials in animals and human infants.