Intratracheal Budesonide Combined With Surfactant in Extremely Preterm Infants

( JAMA . 2024;332(22):1885-1887. DOI:10.1001/jama.2024.19641) Infants born extremely premature, defined as those born at <28 weeks' gestation, are at significant risk for both acute and chronic respiratory disease, primarily due to insufficient pulmonary surfactant. This leads to neonatal respiratory distress syndrome within hours or days after birth in over 90% of these infants. In addition, around half of these infants develop broncho-pulmonary dysplasia (BPD), a chronic lung condition that can cause long-term respiratory and cardiac complications, developmental delays, and even early mortality. BPD is often diagnosed when an infant requires positive airway pressure or supplemental oxygen by 36 weeks of postmenstrual age. Factors contributing to BPD include not only surfactant deficiency but also inflammatory exposures like infections and the use of mechanical ventilation and oxygen therapy, which impede normal lung healing. The incidence of BPD has been rising in recent years, partly due to improved survival rates of extremely preterm infants, with limited effective pharmacological treatments to prevent the disease.