Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned
Abstract Delivery of medications to preterm neonates receiving non-invasive ventilation (NIV) represents one of the most challenging scenarios for aerosol medicine. This challenge is highlighted by the undersized anatomy and the complex (patho)physiological characteristics of the lungs in such infan...
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doaj-2fe612992691401ab9003de22283b8c62021-03-11T11:41:56ZengBMCRespiratory Research1465-993X2021-02-0122113110.1186/s12931-020-01585-9Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learnedFederico Bianco0Fabrizio Salomone1Ilaria Milesi2Xabier Murgia3Sauro Bonelli4Elena Pasini5Raffaele Dellacà6Maria Luisa Ventura7Jane Pillow8Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A.Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A.Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A.Scientific ConsultantDepartment of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A.Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A.TechRes Lab, Dipartimento Di Elettronica, Informazione E Bioingegneria (DEIB), Politecnico Di Milano UniversityNeonatal Intensive Care Unit, Fondazione MBBM-ASST-MonzaSchool of Human Sciences, University of Western AustraliaAbstract Delivery of medications to preterm neonates receiving non-invasive ventilation (NIV) represents one of the most challenging scenarios for aerosol medicine. This challenge is highlighted by the undersized anatomy and the complex (patho)physiological characteristics of the lungs in such infants. Key physiological restraints include low lung volumes, low compliance, and irregular respiratory rates, which significantly reduce lung deposition. Such factors are inherent to premature birth and thus can be regarded to as the intrinsic factors that affect lung deposition. However, there are a number of extrinsic factors that also impact lung deposition: such factors include the choice of aerosol generator and its configuration within the ventilation circuit, the drug formulation, the aerosol particle size distribution, the choice of NIV type, and the patient interface between the delivery system and the patient. Together, these extrinsic factors provide an opportunity to optimize the lung deposition of therapeutic aerosols and, ultimately, the efficacy of the therapy. In this review, we first provide a comprehensive characterization of both the intrinsic and extrinsic factors affecting lung deposition in premature infants, followed by a revision of the clinical attempts to deliver therapeutic aerosols to premature neonates during NIV, which are almost exclusively related to the non-invasive delivery of surfactant aerosols. In this review, we provide clues to the interpretation of existing experimental and clinical data on neonatal aerosol delivery and we also describe a frame of measurable variables and available tools, including in vitro and in vivo models, that should be considered when developing a drug for inhalation in this important but under-served patient population.https://doi.org/10.1186/s12931-020-01585-9Aerosol deliveryNon-invasive ventilationNebulizerPulmonary drug deliveryPremature infantsSurfactant |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Federico Bianco Fabrizio Salomone Ilaria Milesi Xabier Murgia Sauro Bonelli Elena Pasini Raffaele Dellacà Maria Luisa Ventura Jane Pillow |
spellingShingle |
Federico Bianco Fabrizio Salomone Ilaria Milesi Xabier Murgia Sauro Bonelli Elena Pasini Raffaele Dellacà Maria Luisa Ventura Jane Pillow Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned Respiratory Research Aerosol delivery Non-invasive ventilation Nebulizer Pulmonary drug delivery Premature infants Surfactant |
author_facet |
Federico Bianco Fabrizio Salomone Ilaria Milesi Xabier Murgia Sauro Bonelli Elena Pasini Raffaele Dellacà Maria Luisa Ventura Jane Pillow |
author_sort |
Federico Bianco |
title |
Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned |
title_short |
Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned |
title_full |
Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned |
title_fullStr |
Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned |
title_full_unstemmed |
Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned |
title_sort |
aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned |
publisher |
BMC |
series |
Respiratory Research |
issn |
1465-993X |
publishDate |
2021-02-01 |
description |
Abstract Delivery of medications to preterm neonates receiving non-invasive ventilation (NIV) represents one of the most challenging scenarios for aerosol medicine. This challenge is highlighted by the undersized anatomy and the complex (patho)physiological characteristics of the lungs in such infants. Key physiological restraints include low lung volumes, low compliance, and irregular respiratory rates, which significantly reduce lung deposition. Such factors are inherent to premature birth and thus can be regarded to as the intrinsic factors that affect lung deposition. However, there are a number of extrinsic factors that also impact lung deposition: such factors include the choice of aerosol generator and its configuration within the ventilation circuit, the drug formulation, the aerosol particle size distribution, the choice of NIV type, and the patient interface between the delivery system and the patient. Together, these extrinsic factors provide an opportunity to optimize the lung deposition of therapeutic aerosols and, ultimately, the efficacy of the therapy. In this review, we first provide a comprehensive characterization of both the intrinsic and extrinsic factors affecting lung deposition in premature infants, followed by a revision of the clinical attempts to deliver therapeutic aerosols to premature neonates during NIV, which are almost exclusively related to the non-invasive delivery of surfactant aerosols. In this review, we provide clues to the interpretation of existing experimental and clinical data on neonatal aerosol delivery and we also describe a frame of measurable variables and available tools, including in vitro and in vivo models, that should be considered when developing a drug for inhalation in this important but under-served patient population. |
topic |
Aerosol delivery Non-invasive ventilation Nebulizer Pulmonary drug delivery Premature infants Surfactant |
url |
https://doi.org/10.1186/s12931-020-01585-9 |
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