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Optimizing respiratory management in preterm infants: a review of adjuvant pharmacotherapies

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Abstract

Adjuvant respiratory therapies in preterm neonates aim to reduce long-term morbidities and mortality. Commonly utilized therapies include caffeine, systemic glucocorticosteroids, inhaled steroids, inhaled bronchodilators, and diuretics. This review discusses the available literature that supports some of these practices and points out where clinical practices are not corroborated by evidence. Therapies with no proven clinical benefit must be weighed against potential adverse effects.

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Fig. 1: The mechanisms and clinical effects of caffeine therapy in preterm neonates.
Fig. 2: The mechanisms and clinical effects of postnatal steroid therapy in preterm neonates.
Fig. 3: Summary of clinical studies utilizing the different dosing regimens of dexamethasone or hydrocortisone and the relative impact on pulmonary and neurodevelopmental outcomes.
Fig. 4: Schematic representation of delivery of corticosteroids via nebulization versus direct endotracheal instillation using surfactant as a vehicle.

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Acknowledgements

We sincerely thank Dr. Satyanarayana Lakshminrusimha for his feedback and advice on medical illustrations and figures. The Journal Club is a collaboration between the American Academy of Pediatrics—Section of Neonatal Perinatal Medicine and the International Society for Evidence-Based Neonatology (EBNEO.org).

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Authors and Affiliations

  1. Sharp Mary Birch, Hospital for Women & Newborns, San Diego, CA, USA

    Jenny K. Koo & Anup C. Katheria

  2. Sharp Neonatal Research Institute, San Diego, CA, USA

    Jenny K. Koo & Anup C. Katheria

  3. University of California San Diego, San Diego, CA, USA

    Robin Steinhorn

  4. Rady Children’s Hospital, San Diego, CA, USA

    Robin Steinhorn

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  1. Jenny K. Koo
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J.K. and A.K. drafted and contributed equally to the manuscript. RS provided additional feedback and review of content. JK illustrated and created all figures and tables.

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Correspondence to Anup C. Katheria.

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Koo, J.K., Steinhorn, R. & C. Katheria, A. Optimizing respiratory management in preterm infants: a review of adjuvant pharmacotherapies. J Perinatol 41, 2395–2407 (2021). https://doi.org/10.1038/s41372-021-01139-x

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