Natalie Napolitano, MPH, MPH, RRT-NPS (she/her/hers)
Research Clinical Specialist
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Elizabeth Malick, RRT-NPS
Respiratory Therapist
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Nicholas Bamat, MD, MSCE
Attending Neonatologist
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Anna Bustin, PharmD, BCPPS
Clinical Pharmacist
Childrens Hospital of Philadelphia, United States
Disclosure information not submitted.
Kathleen Gibbs, MD
Attending Neonatologist
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Erik Jensen, MD, MSCE
Attending Neonatologist
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Howard Panitch, MD
Attending Pulmonologist
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Title: Formoterol use in Infants with Severe Bronchopulmonary Dysplasia: A case series
INTRODUCTION/HYPOTHESIS: Infants with severe Bronchopulmonary Dysplasia (sBPD) often display signs of obstructive small airways disease responsive to bronchodilators. In certain cases, airway smooth muscle relaxation cannot be sustained with routine use of short acting inhaled bronchodilators. Use of inhaled formoterol may provide long term bronchodilatation and improve ventilation and oxygenation.
Methods: Retrospective review of eight infants with sBPD treated with formoterol. Clinically meaningful parameters for improvement (peak inspiratory pressure (PIP), FiO2) as well as medication side effects (heart rate, potassium, glucose) were collected for 3 days prior to start of Formoterol dosing and 48 hours after maximum dose of Formoterol was delivered. If fewer than two potassium or glucose measurements were obtained during the timeframe, the closest values recorded outside this period were used. Standard treatment strategies included volume guarantee ventilation and an initial Formoterol dose of 10 mcg with a progressive increase to 15 and 20 mcg if short acting bronchodilators were routinely required. Change in clinical values were compared with paired t-test.
Results: Three of the 8 infants reviewed were female. The mean (SD) gestational age was 25.75 (2.31) weeks and birth weight 0.714 (0.274) kg. At time of treatment, the mean (SD) age was 5.0 (2.39) months, and weight was 5.10 (2.70) kg. Formoterol dose was increased to 20 mcg in all except 1 infant who received 15 mcg. The mean change in PIP was -19.85 cmH2O with 7 infants having a statistically significant reduction (range -3.27 to -33.19 cmH2O, p=0.001 or p=0.000). The mean change in FiO2 was 0.08 with 5 infants having a statistically significant reduction (range -0.01 to -0.41 p< 0.000). All except 1 infant had a significant reduction in heart rate (p< 0.001). One infant showed a statistically significant change in both potassium (p=0.029) and heart rate (p=0.002). Both were, however, not clinically significant changes from baseline and remained within normal ranges for age.
Conclusions: Infants with sBPD presenting with bronchospasm uncontrolled with routine use of short acting inhaled bronchodilators may benefit from treatment with inhaled Formoterol. Future research is needed to confirm safety and efficacy of Formoterol use in sBPD.