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Objective <p>To quantify systemic exposure to budesonide following intratracheal administration; evaluate the impact of intratracheal budesonide on blood glucocorticoid activity (cortisol plus betamethasone as cortisol equivalents); and relate the latter to outcomes.</p> Study design <p>Sub-study of the PLUSS randomized trial(ACTRN12617000322336) of intratracheal budesonide with surfactant versus surfactant alone.</p> Result <p>Among 63 infants enrolled at Kidz First Neonatal Care, Auckland, systemic exposure to intratracheal budesonide was low, and cortisol equivalents were similar between intervention groups at 36–48 h (adjusted-ratio-geometric-means = 1.16, 95% CI 0.52–2.57). Antenatal betamethasone &lt;24 h before birth contributed to neonatal blood glucocorticoid activity for up to 24–48 h. Infants above the upper tertile for cortisol equivalents at &lt;60 h, compared with those below the lower tertile, had increased likelihood of severe intraventricular hemorrhage and possibly death.</p> Conclusion <p>Systemic exposure to intratracheal budesonide has little to no effect on cortisol equivalents at 36–48 h. High glucocorticoid activity after birth may be associated with poorer neonatal outcomes.</p>

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Systemic glucocorticoid activity in extremely preterm neonates after antenatal betamethasone and intratracheal budesonide: a sub-study of the PLUSS trial

  • 期刊论文

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  • 发表日期：

    2026年6月22日

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  • Mark De Hora,
  • Paul L. Hofman,
  • Jeanie LY Cheong,
  • Peter G. Davis,
  • Lex W. Doyle,
  • Kate L. Francis,
  • C. Omar F. Kamlin,
  • Brett J. Manley,
  • Christopher JD McKinlay

摘要

Objective

To quantify systemic exposure to budesonide following intratracheal administration; evaluate the impact of intratracheal budesonide on blood glucocorticoid activity (cortisol plus betamethasone as cortisol equivalents); and relate the latter to outcomes.

Study design

Sub-study of the PLUSS randomized trial(ACTRN12617000322336) of intratracheal budesonide with surfactant versus surfactant alone.

Result

Among 63 infants enrolled at Kidz First Neonatal Care, Auckland, systemic exposure to intratracheal budesonide was low, and cortisol equivalents were similar between intervention groups at 36–48 h (adjusted-ratio-geometric-means = 1.16, 95% CI 0.52–2.57). Antenatal betamethasone <24 h before birth contributed to neonatal blood glucocorticoid activity for up to 24–48 h. Infants above the upper tertile for cortisol equivalents at <60 h, compared with those below the lower tertile, had increased likelihood of severe intraventricular hemorrhage and possibly death.

Conclusion

Systemic exposure to intratracheal budesonide has little to no effect on cortisol equivalents at 36–48 h. High glucocorticoid activity after birth may be associated with poorer neonatal outcomes.