Anti-inflammatory therapy in the neonatal intensive care unit: present and future.

Inflammation has been linked to numerous adverse outcomes in newborns. This paper reviews several major sources of inflammation, methods to reduce exposure, current anti-inflammatory drug therapy and future research directions. The first major source of inflammation--chorioamnionitis--is often present long before delivery; postnatal interventions may not alter outcomes. Reducing the exposure of preterm infants to postnatal inflammatory stimuli such as mechanical ventilation and sepsis may be more effective than anti-inflammatory drug therapy in improving outcomes. If anti-inflammatory drug therapy is considered necessary, the only drug currently proven to decrease extubation failure and bronchopulmonary dsyplasia (BPD) is dexamethasone, which is associated with numerous side effects. Erythromycin treatment of Ureaplasma urealyticum has been ineffective in reducing BPD; are trials of azythromycin planned. Research may improve future outcomes by tailoring glucocorticoid dosage, duration and formulation in targeted populations and by developing agents to inhibit specific pro-inflammatory mechanisms.