The combination of betamethasone and Ambroxol for the prophylaxis of neonatal RDS

Abstract

Newborn respiratory distress syndrome (RDS) is still a major cause of morbidity and mortality among preterm infants. Wood and Farrell [1], about 15 years ago, reported that in the USA neonatal deaths due to respiratory problems were approximately 8000 per year. Since then many things have changed, but the incidence of the disease is still variable, depending on the reports and studies, between 15 and 60% in newborns before 35 weeks of gestation. In Italy, for example, over the last few years, the incidence of RDS before 37 weeks has been 6.9% [2]. Because the disease is so frequent and considering the high cost of hospitalization of a newborn with respiratory distress, the use of prevention has been considered necessary, and many drugs have been proposed for this purpose. Among them, the most widely used are steroids [3–5], but in the last few years many trials in Europe have shown the effectiveness of Ambroxol [6,7]. Thyroid hormones, too, have been shown to be effective, but they need to be administered intra-amniotically [8]. In a previous multicentre double-blind study on 66 premature deliveries, we have shown no differences in RDS incidence between the group treated with Ambroxol (A) and another group in which betamethasone (B) was administered (8.8% A vs. 10.5% B), but the analysis of amniotic fluid parameters gave us a significantly higher increase in US ratios and fluorescence polarization values in group A [9].