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Nebulised budesonide in NICU. What are the different options to prevent and treat BPD? Dr Sridhar K

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Hi i’m dr sridhar kalyana sundaram in this quick video i will discuss uh the role of nebulized pulmicortal nebulized buddhisonite in the neonatal intensive care unit so most of us have used nebulous pulmicott in the nicu in different settings so over the past few years i have developed a practice where i am giving it where the baby is not weaning off non-invasive

Support a bacillus study which was published uh a few years ago uh used a punebulas permecot in a big group of babies so they started right from birth in the randomized group and they continued till they were off oxygen or till 32 weeks so it was a significant length of time they were giving the nebulized permicot and in that study even though bpd was reduced there

Was a slightly increased risk of mortality so i wouldn’t give that for such a duration but i use it more in a selective group of patients there are very few established treatments for bronchopermanent dysplasia or chronic lung disease as you would see in the playlist on bpd many experts have discussed it and you can go through those videos as well firstly gentle

Ventilation from the start avoiding unnecessary ventilation by invasive means non-invasive ventilation from the beginning keeping the appropriate pressures that the baby needs avoiding reflux by head and elevation as possible and feeding pattern uh i usually don’t go more than two hourly feeds if the baby is on cpap or high flow at a higher flow three hourly

Feeds is for the bigger babies who are not needing respiratory support so the chances of reflux reduces when you have less milk in the stomach at any stage and that’s a reasoning hourly feeds is not easy for both the baby and the nurse so keep it for very rare situations and continuous feeds is not ideal as well both from the feeding point of view and absorption

Point of view as well as a gut hormone cycle point of view so bonus feeding of two hourly feeds in the small preterm babies is quite a reasonable option and when we talk of other measures nutrition is very important preventing infection is important for preventing vpd as well so keep these measures in the background if a baby has extubated successfully possibly

After a dart regime if needed or if you have succeeded in insurer or lisa and kept the babies on non-invasive modes right away you allow them to stay on such modes for two weeks or so or up to 30 31 weeks of corrected gestation that is the time that you want to try and win the morph if possible and i start nebulous permicot at this stage and most of the babies

Who continue to need cpap or significant flow on high flow i keep dose of 250 microgram twice a day for five to seven days and then i reduce it to 125 microgram twice a day and we continue this till the baby comes off the flow if the baby does not show any response i stop it after another week or so i am against use of diuretics and chronic lung disease mainly

Because there is no significant evidence to show that it changes anything and we all know how negative diuretics can be so even one dose of diuretic the baby may react more even if you use glutathione not lastics and they lose weight they have significant electrolyte disturbances these are the visible effects but there may be so many invisible effects of this fluid

Disturbance in these babies so i avoid using diuretics and pulmicott we believe at least that a course like this is not going to have neurodevelopmental impact the oral steroids as well we are more comfortable using the dart where the bpd risk is high after end of the first week or so another important point is about the appropriate timing of pda treatment because

If you leave it too late then the negative effects have already set in so i would refer you to watch the video by either dr martin luck or patrick mcnamara on this channel as well and i do agree with their viewpoint and it has helped in our practice the iowa based approach where if you do echocardiography in the first two to three days and there is a reasonable

Sized pda you treat it early and paracetamol treatment when you start early it seems to work better if it doesn’t respond to the paracetamol and the baby is reasonably stable you can start broofin as a trial as well so timing of treatment of the pda also influences your chronic lung disease it might influence your rate of necrotizing intracoalitus if your pda

Closes and it doesn’t interfere with the gut flow for these babies so this is a practical video on management of chronic lung disease and use of pulmicott in the neonatal intensive care ah i rarely use pelmicotton a ventilated baby it’s not worth interrupting the ventilator pattern with the nebulizer when the effects are dubious so mostly it’s non-invasively

Ventilated babies who are stuck on it for some time who are approaching the time when you want them to move to suck feeds so i hope this video is helpful and please do share thank you

Transcribed from video
Nebulised budesonide in NICU. What are the different options to prevent and treat BPD? Dr Sridhar K By Sridhar K