Management of Chronic Lung Disease in Infants

Introduction to Inhaled Corticosteroids

• Inhaled corticosteroids may be used in infants with established chronic lung disease, but systemic steroids should be avoided due to serious adverse neurological outcomes 1
• The National Institute of Child Health and Human Development explicitly discourages routine use of oral corticosteroids in infants due to side effects and lack of long-term benefit 1

Benefits and Preferred Route of Administration

• Inhaled corticosteroids have benefits including reduced symptoms and improved lung function in infants with chronic lung disease of infancy (CLDI) 1
• Inhaled corticosteroids decrease the need for bronchodilator therapy in infants with CLDI 1
• Inhaled corticosteroids have fewer systemic side effects compared to oral administration 1
• The preferred route of administration when steroids are necessary for infants with CLDI is via a metered-dose inhaler (MDI) with spacer, which is preferred over nebulization 1
• A face mask helps ensure optimal drug delivery when using an MDI with spacer 1

Patient Selection and Monitoring

• Inhaled corticosteroids are considered for established chronic lung disease of infancy (CLDI) with asthma-like symptoms 1
• Inhaled corticosteroids are considered for symptomatic premature infants at follow-up with CLDI 1
• Monitor for potential side effects including delayed growth, increased blood pressure, osteoporosis, adrenal suppression, and cataracts 1
• Prevent oral candidiasis by rinsing the child's mouth after inhaled corticosteroid use and timing inhaled corticosteroid use just before tooth brushing 1, 2

Best Practices for Administration

• Use the lowest effective dose for the shortest possible duration when administering steroids 1
• MDI with spacer is preferred over nebulization due to reduced systemic side effects and improved drug delivery 1
• Regular assessment of growth, blood pressure, and development is essential when administering steroids to infants 1