• Recommendation
    		•

    Treatment of respiratory disease




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    Treatment of respiratory disease: Systematic review of 3 trials including 140 infants comparing salbutamol versus placebo in near term or term infants less than three days of age with transient tachypnoea of the newborn found a reduction in the duration of oxygen therapy (MD -43.10 hours 95% CI -81.60 to -4.60), but no difference in the need for CPAP, mechanical ventilation or duration of hospital stay and tachypnoea. At present there is insufficient evidence to determine the efficacy and safety of salbutamol in the management of transient tachypnoea of the newborn.5
    Systematic review6 found a single study that reported prophylaxis of preterm infants at risk of chronic lung disease with salbutamol led to no difference in mortality (RR 1.08, 95% CI 0.50 to 2.31) or CLD (RR 1.03, 95% CI 0.78 to 1.37). There is no evidence for the use of salbutamol for prevention of chronic lung disease.
    Recommendation: There is insufficient evidence to recommend use of nebulised salbutamol in newborn infants with respiratory disease. (LOE I GOR C)
    Pharmacokinetics

    Reports describing the pharmacokinetics of intravenous salbutamol in neonates and children are limited. Kirpalani et al studied the pharmacokinetics of a single dose of intravenous salbutamol in six preterm infants (GA 24 to 28 weeks), postnatal age 54 to 105 days, with bronchopulmonary dysplasia.7 The elimination half-life of salbutamol was 118 minutes (range 69 to 162 minutes) volume of distribution was 1291 mL/kg (range 246 to 2997) and clearance 7.5 mL/kg/min (range 2.46 to 20.1).7 The authors noted that the elimination half-life in their neonates was slightly shorter than that of healthy adults.7




    References

    Singh B, Sadiq H, Noguchi A and Keenan W. (2002). Efficacy of albuterol inhalation in treatment

    of hyperkalemia in premature neonates. The Journal of Pediatrics, 141(1), pp.16-20.

    2. Greenough A, Emery E, Brooker R and Gamsu H (1992). Salbutamol infusion to treat neonatal

    hyperkalaemia. Journal of Perinatal Medicine, 20(6), pp.437-441.

    3. Murdoch I, Dos Anjos R and Haycock G. (1991). Treatment of hyperkalaemia with intravenous

    salbutamol. Archives of Disease in Childhood, 66(4), pp.527-528.

    4. Kemper M, Harps E, Hellwege H and Müller-Wiefel D. (1996). Effective treatment of acute

    hyperkalaemia in childhood by short-term infusion of salbutamol. European Journal of

    Pediatrics, 155(6), pp.495-497.

    5. Moresco L, Bruschettini M, Cohen A, Gaiero A, Calevo MG. Salbutamol for transient tachypnea

    of the newborn. Cochrane Database Syst Rev. 2016.

    6. Ng G, da Silva O, Ohlsson A. Bronchodilators for the prevention and treatment of chronic lung

    disease in preterm infants. Cochrane Database Syst Rev. 2016.

    7. Kirpalani H, Doren G, Schmidt B, Tan Y, Santos R, Soldin S. (1990). Respiratory response and

    pharmacokinetics of intravenous salbutamol in infants with bronchopulmonary dysplasia.

    Critical Care Medicine, 18(12), pp. 1374-1377.

    8. Mandelberg A, Krupnik Z, Houri S, Smetana S, Gilad E, Matas Z, Priel IE. Salbutamol metered-

    dose inhaler with spacer for hyperkalemia: how fast? How safe?. CHEST Journal. 1999 Mar

    1;115(3):617-22

    9. Yaseen H, Khalaf M, Dana A, Yaseen N, Darwich M. Salbutamol versus cation-exchange resin

    (kayexalate) for the treatment of nonoliguric hyperkalemia in preterm infants. American journal, f perinatology. 2008 Feb;25(03):193-7.






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