6ER-013 A pilot randomised double-blinded placebo-controlled trial of prophylactic sildenafil in preterm infants at risk of bronchopulmonary dysplasia

Abstract Background: Preterm mothers at risk of delayed lactogenesis II may benefit from early pharmcological intervention to initiate breastfeeding onset. Research aim. To evaluate the effect of oral metoclopramide on lactogenesis II in mothers of preterm infants commencing within twelve hours of delivery. Methods: From April 2006 to May 2009,105 women were randomized to metoclopramide (term births, n=36;reterm n=20) or placebo (term,n=33;preterm,n=16). Mothers received 30 mg of oral metoclopramide daily for the first postnatal week in a randomized double-blinded placebo-controlled study. Primary outcome was augmentation of Lactogenesis II onset by postnatal day 3. Secondary outcomes were daily expression of breastmilk and maternal perception of lactogenesis II, breastfeeding practice and infant weight change over 6 months. Results: Metoclopramide achieved 25% augmentation in lactogenesis II onset (p=0.09) with greater expressed human milk volumes in mothers of preterm infants. Daily expressed human milk volumes was higher among preterm mothers on metoclopramide compared to term placebo mothers who served as controls, significant on day 2 (19.9 vs 2.4ml, p=0.04) and day 3 (32.6 vs 8.8ml,p=0.04),and total expressed human milk volumes had increased by 8.2 fold by the end of week one. Most mothers reported first initiation of lactogenesis II by day 6, with 95-100% of term mothers confirmed by day 5 (not significant). Conclusions: Short-term metoclopramide use starting within 12 postnatal hours boosted lactogenesisi II onset in preterm mothers, improving daily expressed human milk production and maternal perception of lactogenesis II onset.

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Respiratory and systemic effects of inhaled dexamethasone on ventilator dependant preterm infants at risk for bronchopulmonary dysplasia

The Indian Journal of Pediatrics ◽

10.1007/bf02752304 ◽

1998 ◽

Vol 65 (2) ◽

pp. 273-282 ◽

Cited By ~ 9

Author(s):

Marianne Pappagallo ◽

Soraya Abbasi ◽

Vinod K. Bhutan

Keyword(s):

At Risk ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Systemic Effects

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Effects of Postnatal Hydrocortisone Treatment on Cytokine Profile in Preterm Infants at Risk of Bronchopulmonary Dysplasia

10.21203/rs.3.rs-674256/v1 ◽

2021 ◽

Author(s):

Kentaro Tamura ◽

Mitsuhide Nagaoka ◽

Satomi Inomata ◽

Yukako Kawasaki ◽

Masami Makimoto ◽

...

Keyword(s):

At Risk ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Early Phase ◽

Late Phase ◽

High Serum ◽

Duration Of Treatment ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Hydrocortisone Treatment

Abstract Systemic hydrocortisone administration has been widely used in preterm infants who are at a risk of bronchopulmonary dysplasia (BPD). However, the effects of hydrocortisone on cytokine profiles have not been examined. We aimed to investigate the effects of postnatal hydrocortisone treatment on serum cytokine levels in extremely preterm infants at risk for BPD. In 29 extremely preterm infants (born at less than 28 weeks of gestational age), we obtained serum from blood samples collected during an early phase (5–20 days) and a late phase (28‒60 days) after birth. We measured the levels of proinflammatory cytokines (tumor necrosis factors α and β, interleukin [IL]-1β, and IL-6), T-helper (Th) 1 cytokines (interferon-γ, IL-2, and IL-12p70), Th2 cytokines (IL-4, IL-5, and IL-10), Th17 cytokine IL-17A, and chemokine IL-8. We found that serum IL-6 and IL-8 levels were significantly higher during the early phase than during the late phase (both P = 0.03). Other cytokines concentrations did not change between the phases. Thirteen infants (45%) received systemic hydrocortisone treatment at a median age of 15 days (IQR 10.0–21.5) after birth due to respiratory deterioration, after which the serum IL-6 levels significantly decreased (P = 0.04). Median duration of treatment was 16.0 (IQR 8.0–34.5) days. Conclusion: Extremely preterm infants show high serum IL-6 and IL-8 levels in the early phase of life. Moreover, postnatal systemic hydrocortisone treatment might suppress IL-6 overproduction.

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