165 - Effects of the combination of surfactant with budesonide and intravenous hydrocortisone on betamethasone treated preterm lambs

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 165
Publication Number: 165.438

Hayley Grzych, SSM Cardinal Glennon Children's Medical Center, St Louis, MO, United States; Erin L. Fee, University of western australia, Crawley, Western Australia, Australia; Matt Kemp, National University of Singapore, Singapore, N/A, Singapore; Haruo Usuda, The University of Western Australia, Subiaco, Western Australia, Australia; Hideyuki Ikeda, The University of Western Australia, Perth, Western Australia, Australia; Yuki Takahashi, The University of Western Australia, Crawley, Western Australia, Australia; Tsukasa Takahashi, University of Western Australia, Crawley, Western Australia, Australia; Alan H. Jobe, Cincinnati Children's Hospital, Cincinnati, OH, United States; Noah Hillman, Saint Louis University School of Medicine, St. Louis, MO, United States

Presenting Author(s)

Hayley Grzych, MD (she/her/hers)

Neonatal-Perinatal Medicine Fellow
SSM Cardinal Glennon Children's Medical Center
St Louis, Missouri, United States

Background: The combination of surfactant with budesonide decreased lung injury and ventilation physiology in preterm lambs, and may decrease BPD rates and severity in preterm infants. Hydrocortisone has also demonstrated decreased BPD rates. If both steroids are beneficial, it will be important to determine if combining them is safe. Whether beneficial effects of the combination of surfactant and budesonide found in preterm ventilated lambs are also found after antenatal betamethasone is not known.

Objective:

To evaluate the effects of antenatal steroids, budesonide with surfactant, and hydrocortisone on lung and systemic injury from mechanical ventilation at birth.

Design/Methods:

Date-mated Ewes at 123±1 day gestational age received intramuscular betamethasone 0.25 mg/kg at 48 hours and 24 hours prior to delivery at 125±1 day (n=7-8/group). Lambs were ventilated with high tidal ventilation for 15 minutes then normal tidal volume ventilation for 4 hours. At 15 min, lambs received 200 mg/kg Curosurf with or without 0.25 mg/kg of budesonide (Bud) via ET tube, and either IV saline or IV Hydrocortisone 1 mg/kg (Hydro). Lambs were continuously monitored and physiology recorded. Molecular analysis of lung, liver and brain tissues is underway.

Results: Overall, animals receiving budesonide and surfactant have improved ventilation and oxygenation versus animals only receiving saline (Table). Volume at 40 cmH2O was higher with budesonide. Mean blood pressure were higher in budesonide and hydrocortisone groups.

Conclusion(s): Even after antenatal steroids, the beneficial effects of surfactant with budesonide on ventilation physiology, oxygenation, and ventilation still exist. Hydrocortisone improved blood pressure, but had minimal effects on lung physiology. Molecular analysis is underway to evaluate systemic effects.