What is the recommended dosage of salbutamol (albuterol) for a 35-week-old preterm infant?

Salbutamol Dosage for a 35-Week-Old Preterm Infant

For a 35-week-old preterm infant, the recommended dosage of salbutamol (albuterol) via nebulizer is 0.15 mg/kg (minimum dose 1.25 mg) every 20 minutes for up to 3 doses, then 0.075-0.15 mg/kg every 1-4 hours as needed. 1

Dosing Guidelines

Nebulized Administration

• Initial treatment: 0.15 mg/kg (minimum dose 1.25 mg) every 20 minutes for up to 3 doses
• Maintenance dosing: 0.075-0.15 mg/kg every 1-4 hours as needed
• Dilute in 2-3 mL of saline solution for adequate nebulization

Metered-Dose Inhaler (MDI) with Spacer

• Alternative delivery method: 4-8 puffs via MDI with a valved holding chamber every 20 minutes for 3 doses, then as needed 1, 2
• MDI with spacer has been shown to be as effective as nebulization in preterm infants 3, 4

Clinical Considerations

Indications for Use

• Bronchospasm with increased work of breathing
• Prolonged expiratory phase
• Use of accessory muscles of respiration 1
• Recurrent respiratory symptoms (cough, wheeze) in infants with post-prematurity respiratory disease 1

Monitoring

• Observe for:
  • Heart rate (tachycardia is a common side effect)
  • Oxygen saturation (maintain SaO₂ >92%)
  • Respiratory rate and effort
  • Clinical response (improvement in wheezing, work of breathing)

Response Assessment

• Assess response within 15-30 minutes after administration
• If no improvement after initial treatment, consider:
  • Increasing frequency of administration
  • Adding ipratropium bromide 100 μg nebulized every 6 hours 1

Evidence-Based Considerations

Efficacy in Preterm Infants

• Bronchodilator responsiveness is not universal in preterm infants 1
• Response is more likely in infants with:
  • Recurrent respiratory symptoms (55% response rate vs. 12.5% in asymptomatic infants) 1
  • Abnormal baseline lung function 1

Delivery Method Considerations

• MDI with spacer has shown equal or better efficacy compared to jet nebulizers in preterm infants 3, 4
• 200 μg salbutamol via MDI with spacer has been shown to improve compliance and resistance in preterm infants 1
• Ultrasonic nebulizers and MDI with spacer are more efficient than jet nebulizers for preterm infants 4

Important Caveats

1. Individualized Response: Monitor clinical response carefully as not all preterm infants respond to bronchodilators 1

2. Potential Side Effects:

   • Tachycardia (reduce rate if heart rate decreases by 10 beats/min)
   • Tremors
   • Hyperactivity

3. Limited Long-term Evidence: Trials have not demonstrated that regular bronchodilator therapy improves long-term outcomes in ventilated preterm infants 1

4. Delivery Technique: Proper technique is crucial for effective medication delivery:

   • Use appropriate spacer device for MDI administration
   • Ensure proper mask fit for nebulizer delivery
   • Oxygen is the preferred gas source for nebulization 1

For this 35-week-old preterm infant, start with the recommended dosage and carefully monitor clinical response, adjusting treatment based on symptom improvement and side effects.