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Salbutamol improves TTN symptoms in trial

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In a randomized, double-blinded trial of 54 infants with tachypnea, a dose of inhaled salbutamol improved respiratory rate, inspired oxygen, and other measures of the condition compared to a placebo.

Noting the lack of other effective early treatment options, the authors write in The Journal of Pediatrics that salbutamol could be clinically useful – but that larger studies are needed to confirm their findings.

Dr. Didem Armangil and his colleagues from Hacettepe University in Ankara, Turkey randomly assigned the 54 newborns, all with a gestational age of 34 to 39 weeks and diagnosed with transient tachypnea of the newborn (TTN), to 4 mL of the beta-2 agonist salbutamol (0.15 mg/kg) or a saline solution. Doses of both the treatment and placebo were administered over 20 minutes with a jet type nebulizer that provided a continuous oxygen flow of 5-6 L/min.

IV fluids were given at 60 mL/kg/d for term newborns and 80 mL/kg/d for preterm babies during the first day after birth.

Four hours after treatment, the 32 babies assigned to salbutamol had significantly improved TTN clinical scores, respiratory rates, and fraction of inspired oxygen (FiO2) than pretreatment, while the control group did not improve.

Babies treated with a dose of salbutamol dropped from a median of 8 to 2.5 on the TTN clinical score (scale range: 0 to 13), while control babies held steady at a median score of 7. Average respiratory rate improved from 70 to 62 beats per minute in the salbutamol group, but was not statistically changed with placebo treatment (74 bpm before versus 77 bpm after.) FiO2 dropped from 70% to 21% with salbutamol, but held steady at 60% in the controls (all salbutamol improvements P < 0.01). There was also a significant improvement in pH with salbutamol treatment but not with the placebo. The level of respiratory support was decreased in salbutamol babies compared with control babies, with NICU stay significantly shorter in the treatment group as well. No differences between groups were observed for serum potassium or glucose, or for heart rate following treatment. Researchers did not compare airway pressure and resistance values in the two groups of newborns. Dr. Armangil and colleagues note that past studies have found that both epinephrine and furosemide are not effective treatments for TTN – which is thought to be a result of delayed resorption of fluid from the newborn’s lungs. The authors say that verification of the findings is necessary, but conclude that, “a therapy (such as salbutamol) that reduces the duration and severity of this disorder may have practical value. A therapy that is effective early in the course of TTN would decrease treatment burden and resource utilization.” Reference:
Inhaled Beta-2 Agonist Salbutamol for the Treatment of Transient Tachypnea of the Newborn

J Pediatr 2011.