• Sybrich Tiemersma, Stefan Minocchieri, Richard A van Lingen, Mathias Nelle, and Sunalene G Devadason.
• 1 Princess Amalia Department of Paediatrics, Division of Neonatology, Isala Clinics , 8000 GK Zwolle, The Netherlands .
• J Aerosol Med Pulm Drug Deliv. 2013 Oct 1;26(5):280-6.

BackgroundAerosol therapy in preterm infants is challenging, as a very small proportion of the drug deposits in the lungs.AimOur aim was to compare efficiency of standard devices with newer, more efficient aerosol delivery devices.MethodsUsing salbutamol as a drug marker, we studied two prototypes of the investigational eFlow(®) nebulizer for babies (PARI Pharma GmbH), a jet nebulizer (Intersurgical(®) Cirrus(®)), and a pressurized metered dose inhaler (pMDI; GSK) with a detergent-coated holding chamber (AeroChamber(®) MV) in the premature infant nose throat-model (PrINT-model) of a 32-week preterm infant (1,750 g). A filter or an impactor was placed below the infant model's "trachea" to capture the drug dose or particle size, respectively, that would have been deposited in the lung.ResultsLung dose (percentage of nominal dose) was 1.5%, 6.8%, and 18.0-20.6% for the jet nebulizer, pMDI-holding chamber, and investigational eFlow nebulizers, respectively (p<0.001). Jet nebulizer residue was 69.4% and 10.7-13.9% for the investigational eFlow nebulizers (p<0.001). Adding an elbow extension between the eFlow and the model significantly lowered lung dose (p<0.001). A breathing pattern with lower tidal volume decreased deposition in the PrINT-model and device residue (p<0.05), but did not decrease lung dose.ConclusionsIn a model for infant aerosol inhalation, we confirmed low lung dose using jet nebulizers and pMDI-holding chambers, whereas newer, more specialized vibrating membrane devices, designed specifically for use in preterm infants, deliver up to 20 times more drug to the infant's lung.

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