Effect Of Nebulized Budesonide In Improving The Clinical Outcome Of Neonates With Meconium Aspiration Syndrome

Suresh Rangaraj
7.769 1.698


Aim and Objective: To study the effect of nebulized steroid in improving the clinical outcome in terms of morbidity and mortality in neonates with meconium aspiration syndrome.

Design: Prospective open labeled randomized controlled trial.

Setting: Tertiary care teaching hospital.

Patients: Full term babies with diagnosis of meconium aspiration syndrome(MAS) admitted in the NICU of Cheluvamba Hospital attached to Mysore Medical College and Research Institute  were included in the study.

Intervention: Administration of nebulized budesonide in a dose of 50µg in 2.5ml normal saline through jet nebulizer every 12hourly from second day of life till 7days or clinical recovery whichever is earlier.

Results: A Total of 60 patients with diagnosis of MAS were admitted to the NICU during the period of August - October 2013,out of them 20 were excluded,so a total of 40 patients were included in the study,20 in control group(Group A),20 in budesonide group (Group B). The baseline clinical profile of both the groups were similar.Duration of  respiratory distress in days (2.63 vs 5.24 p=0.0493), duration of oxygen dependency (2.37 vs 4.94 p=0.0406), duration of hospital stay (7.58 vs 10.47 p=0.0430), time taken for achievement of full feeds (3.79 vs 8.76 p=0.0002) and the need for mechanical ventilation (0 vs 0.2 p=0.0356) were statistically less in budesonide treated group as compared to the controls.Incidence of  sepsis is similar in both the groups. Complications were similar in both the groups and no specific adverse effects were  noted in the steroid treated group. Four patients died during the hospital stay,three in the control group and one in the case group .Out of them two patients died due to pneumothorax and both of them belong to the control group,other two patients died due to sepsis with disseminated intravascular coagulation(DIC), representing one each from control and case group.

Conclusion: Nebulized budesonide improves the clinical outcome in terms of  morbidity and is relatively safe,however long term follow-up is needed to recommend inhalation route of steroids as safe and effective.


Budesonide, Meconium aspiration syndrome, Steroid

Full Text:


DOI: http://dx.doi.org/10.17334/jps.01771


1- Macdonald MG, Mullet MD, Seshia MMK. Avery’s Neonatology 2005;6:562-565.

2- Wiswell TE, Bent RC. Meconium staining and the Meconium

issues. Pediatr Clin North Am 1993; 40: 755-981.

3- Kojima T, Hattori K, Fujiwara T, Kojima T, Hattori K, Fujiwara T, Sasai-Takedatsu M, Kobayashi Y. Meconium induced lung injury mediated by activation of alveolar macrophages. Life Sci 1994; 4: 1559-62.

4- Ward M,Sinn J. Steroid therapy for meconium aspiration syndrome in newborn infants. Cochrane Database Syst Rev 2003; 4: CD003485.

5- Lwanga SK, Lemeshow S. Sample size determination in health studies; A practical manual. WHO; Geneva,1991.

6- Tripathi S, Saili A. The effect of steroids on the clinical course and outcome of neonates with Meconium aspiration syndrome. J Trop Pediatr 2007; 53(1): 8-12.

7- Yeh TF, Srinivasan G, Harris V, Pildes RS. Hydrocortisone therapy in meconium aspiration syndrome;a controlled study. J Pediatr 1977; 90: 140- 3.

syndrome,unresolved 8- Singh M. Respiratory disorders. In: Singh M (ed). Care of the Newborn, 6th edn. New Delhi; Sagar publications, 2004; 196-218.

9- Gerand M, Cleary DO, Wistell TE. Meconium stained amniotic fluid and the meconium aspiration syndrome; an update. Pediatr Clin N Amer 1998; 45: 511-29.

10- Frantz ID, Wang NS, Thach BT. Experimental meconium aspiration. Effect of glucocorticoid treatment. J Pediatr 1975; 86: 438-41.

11- Andrew M, Davey AM. Randomized controlled trial of early dexamethasone therapy in the treatment of meconium aspiration syndrome. Pediatr Res 1995; 37: 329-35.

12- Kirimi E, Tuncer O, Kösem M, Ceylan E, Tas A, Tasal I. et al. The effects of prednisolone and serum malondialdehyde levels in puppies with experimentally

syndrome. J Int Med Res.2003;31:113-22.

13- Halliday HL, Patterson CC, Halahakoon CW. A Multicenter randomized open study of early corticosteroid treatment in preterm infants with respiratory illness comparison of early and late treatment and of dexamethasone and inhaled budesonide. Pediatrics.2001; 107: 232-40. aspiration