Gentle medication for the little ones – with every breath

According to the WHO, ten percent of babies worldwide are born prematurely. Since most organs of these tiny babies have not fully formed and developed yet, it can quickly lead to complications and disorders and most notably affect the lungs of the premature infants. What’s more, infections require gentle treatment, as the preemies themselves are very fragile and susceptible – making this a very challenging situation.

In this interview with MEDICA-tradefair.com, Dr. Gerhard Pohlmann talks about the risk for lung disease in premature babies, explains why this is so difficult to treat and reveals how an innovative medication dispensing system can improve the treatment.

Dr. Pohlmann, premature babies are especially susceptible to respiratory problems. Why is that?

Dr. Gerhard Pohlmann: They often don't have enough surfactant, which is needed for lung development. To compensate for this deficiency, you usually first try to treat the babies using gentle breathing support until they produce sufficient amounts of surfactant on their own. However, this treatment can actually lead to lung disease or so-called bronchopulmonary dysplasia. To prevent this from happening, the preemies are treated with surfactant. Premature babies are more susceptible to infections because of the breathing support or simply because their immune system is still immature.

Why is it so difficult to treat lung disease in premature babies?

Pohlmann: The problem is that the typical inhalation delivery systems were developed to facilitate direct pulmonary treatment options with medications such as antibiotics for adult patients. However, premature infants don't breathe like adults. They usually breathe very rapidly, while simultaneously exhibiting lower tidal volumes. They also tend to have very short inhalation periods. The ratio here is about one-third inhalation to two-thirds exhalation. That means the depth of breathing and the time the aerosol treatment stays in the lungs is insufficient.

You have developed a system that improves the treatment of premature babies. How does it work?

Pohlmann: When you treat premature babies with lung disease, the emphasis is on adapting the aerosol dose to the specific breathing needs of the tiny patients. We believe that one way of accomplishing this is to not administer aerosol into the airflow but to apply it directly to the patient interface – to the nose of premature infants for example. The medication is often very expensive to where it also makes financial sense to administer the drug only during the short inhalation phase. In our particular case, the aerosol is a synthetic lung surfactant in dry powder form, which is subsequently moistened to accommodate the premature babies. This makes the treatment better and more efficient because the system is adapted to the specific anatomical characteristics, respiratory rates and depths of the premature infants. Our aim is to facilitate an effective way to treat preterm babies with different types of medications. Once the development has been completed, the system will be suitable for both the application of liquids and the continuous application of moistened powders.

What important aspects do you need to consider during the treatment?

Pohlmann: You have to consider that the tiny patients are susceptible to infections. We must keep that in mind when we introduce any respiratory or inhalation systems to premature tissue. What's more, the moisture of the added air has to be precise. Premature babies should not be administered air that's too dry because the tissue of the tiny patients is very susceptible to dry air and a dry out of the aerosol particles must be avoided. Another factor in the application of aerosol medications for premature babies is the moisturizing of aerosols, which requires precise adaptation.

Do you see a potential of the system for other applications?

Pohlmann: Because the system is able to respond relatively quickly, we also see great potential in a more targeted application of inhaled antibiotics. That means we can administer the drug more precisely in shorter time frames and focus on the treatment of certain lung areas. The way the system is currently set up, it can essentially be used to treat children, premature infants, and adults.