Background: We hypothesized that the use of inhaled budesonide (BUD) would alter somatic growth by increasing energy expenditure (EE) in premature infants with chronic lung disease (CLD). Methods: A prospective study was conducted of the effect of BUD on EE, growth and salivary cortisol excretion in infants with CLD who required supplemental oxygen and were treated with inhaled BUD for 4 weeks according the severity of their CLD, or without BUD treatment. Infants were compared with a healthy control group matched for gestational age. EE, anthropometric measures and salivary cortisol levels were examined before, during and after BUD treatment. Results: A total of 30 spontaneously breathing premature infants were enrolled in the study. EE in CLD (BUD) and CLD (no BUD) patients were greater than EE in healthy preterm infants (p < 0.01) at the study time points. Growth did not differ between the groups. Salivary cortisol levels of treated infants were significantly lower when compared with the levels of nontreated infants. Conclusion: The administration of inhaled BUD in preterm infants with CLD was associated with an increase in EE, a suppression of endogenous cortisol production and with no effect on duration of supplemental oxygen, but did not compromise their somatic growth.

1.
Bolt RJ, van Weissenbruch MM, Lafeber HN, Delemarre-van de Waal HA: Glucocorticoids and lung development in the fetus and preterm infant. Pediatr Pulmonol 2001;32:76–91.
2.
Cole CH: Postnatal glucocorticoid therapy for treatment and prevention of neonatal chronic lung disease. Expert Opin Investig Drugs 2000;9:53–67.
3.
Yeh TF, Lin YJ, Lin HC, Huang CC, Hsieh WS, Lin CH, Tsai CH: Outcomes at school age after postnatal dexamethasone therapy for lung disease of prematurity. N Engl J Med 2004;350:1304–1313.
4.
Cole CH: Inhaled glucocorticoid therapy in infants at risk for neonatal chronic lung disease. J Asthma 2000;37:533–543.
5.
LaForce WR, Brudno DS: Controlled trial of beclomethasone dipropionate by nebulization in oxygen- and ventilator-dependent infants. J Pediatr 1993;122:285–288.
6.
Kovacs L, Davis GM, Faucher D, Papageorgiou A: Efficacy of sequential early systemic and inhaled corticosteroid therapy in the prevention of chronic lung disease of prematurity. Acta Paediatr 1998;87:792–798.
7.
Chong PK, Jung RT, Scrimgeour CM, Rennie MJ: The effect of pharmacological dosages of glucocorticoids on free living total energy expenditure in man. Clin Endocrinol 1994;40:577–581.
8.
Tataranni PA, Larson DE, Snitker S, Young JB, Flatt JP, Ravussin P: Effects of glucocorticoids on energy metabolism and food intake in humans. Am J Physiol 1996;271:E317–E325.
9.
Leitch CA, Ahlrichs J, Karn C, Denne SC: Energy expenditure and energy intake during dexamethasone therapy for chronic lung disease. Pediatr Res 1999;46:109–113.
10.
De Gamarra E: Energy expenditure in premature newborns with bronchopulmonary dysplasia. Biol Neonate 1992;61:337–344.
11.
De Meer K, Westerterp KR, Houwen RH, Brouwers HA, Berger R, Okken A: Total energy expenditure in infants with bronchopulmonary dysplasia is associated with respiratory status. Eur J Pediatr 1997;156:299–304.
12.
Bauer J, Maier K, Muehlbauer B, Poeschl J, Linderkamp O: Energy expenditure and plasma catecholamines in preterm infants with chronic lung disease. Early Hum Dev 2003;72:147–157.
13.
Bancalari E, Nelson C, Sosenko I: Bronchopulmonary dysplasia: changes in pathogenesis, epidemiology and definition. Semin Neonatol 2003;8:63–71.
14.
Boehler T, Kraemer T, Janecke A, Hoffmann GF, Linderkamp O: Increased energy expenditure and fecal fat excretion do not impair weight gain in small-for-gestational age. Early Hum Dev 1999;54:223–234.
15.
Bauer J, Maier K, Linderkamp O, Hentschel R: Effect of caffeine on oxygen consumption and metabolic rate in very low birth weight infants with idiopathic apnea. Pediatrics 2001;107:660–663.
16.
Stothers JK, Warner RM: Oxygen consumption and neonatal sleep state. J Physiol 1978;278:435–440.
17.
Bauer J, Sontheimer D, Fischer C, Linderkamp O: Metabolic rate and energy balance in very low birth weight infants during kangaroo holding by their mothers and fathers. J Pediatr 1996;129:608–611.
18.
Bauer J, Hentschel R, Linderkamp O: Effect of sepsis syndrome on neonatal oxygen consumption and energy expenditure. Pediatrics 2002;110:e69. http://www.pediatrics.org/cgi/content/full/110/6/e69.
19.
Sauer PJJ: Neonatal energy metabolism; in Richard CM (ed): Principles of Perinatal-Neonatal Metabolism. New York, Springer, 1997, pp 1027–1043.
20.
Freymond D, Schutz Y, Decombaz J, Micheli JL, Jequier E: Energy balance, physical activity, and thermogenic effect of feeding in premature infants. Pediatr Res 1986;20:638–645.
21.
Hermanussen M, Seele K: Mini-knemometry: an accurate technique for lower leg length measurements in early childhood. Ann Hum Biol 1997;24:307–313.
22.
Bettendorf M, Albers N, Bauer J, Heinrich UE, Linderkamp O, Maser-Gluth C: Longitudinal evaluation of salivary cortisol levels in full-term and preterm neonates. Horm Res 1998;50:303–308.
23.
Thureen PJ: Measuring energy expenditure in preterm and unstable infants. J Pediatr 2003;142:366–367.
24.
Bauer J, Maier K, Hellstern G, Linderkamp O: Longitudinal evaluation of energy expenditure in preterm infants with birth weight less than 1,000 g. Br J Nutr 2003;9:533–537.
25.
Bauer K, Laurenz M, Ketteler J, Versmold H: Longitudinal study of energy expenditure in preterm neonates <30 weeks’ gestation during the first three postnatal weeks. J Pediatr 2003;42:390–396.
26.
Weiler HA, Wang Z, Atkinson SA: Whole body lean mass is altered by dexamethasone treatment through reductions in protein and energy utilization in piglets. Biol Neonate 1997;71:53–59.
27.
Darmaun D, Matthews DE, Bier DM: Physiological hypercortisolemia increases proteolysis, glutamine, and alanine production. Am J Physiol 1988;255:E366–E373.
28.
Welle S, Nair KS: Relationship of resting metabolic rate to body composition and protein turnover. Am J Physiol 1990;258:E990–E998.
29.
Brillon D, Zheng B, Campell R, Mathwes D: Effect of cortisol on energy expenditure and amino acid metabolism in humans. Am J Physiol 1995;268:E501–E513.
30.
Haggarty P: The effect of isotope sequestration and exchange. The double-labelled water method for measuring energy expenditure. Technical recommendations for use in humans; in Prentice AM (ed): A Consensus Report by the IDECG Working Group. Vienna, IAEA, 1990, pp 114–116.
31.
Ng PC, Fok TF, Wong GW, Lam CW, Lee CH, Wong MY, Lam K, Ma C: Pituitary-adrenal suppression in preterm, very low birth weight infants after inhaled fluticasone propionate treatment. J Clin Endocrinol Metab 1998;83:2390–2393.
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