What is the per kg dose of budesonide (corticosteroid) for an infant?

Budesonide Dosing for Infants

For infants with persistent asthma, the recommended budesonide inhalation suspension dose is 0.25-0.5 mg daily, administered via nebulizer. 1

Budesonide Dosing Guidelines for Infants

Nebulized Budesonide for Asthma

• For infants under 4 years of age with persistent asthma, the low daily dose of budesonide inhaled suspension for nebulization is 0.25-0.5 mg 1
• Medium daily dose for infants under 4 years is >0.5-1.0 mg 1
• Budesonide nebulizer suspension is the only inhaled corticosteroid with FDA-approved labeling for children <4 years of age 1

Administration Considerations

• For infants, budesonide should be administered through a face mask that fits snugly over nose and mouth, avoiding nebulizing in the eyes 1
• The face should be washed after each treatment to prevent local side effects 1
• Budesonide suspension is compatible with albuterol, ipratropium, and levalbuterol nebulizer solutions in the same nebulizer 1
• Only jet nebulizers should be used because ultrasonic nebulizers are ineffective for suspensions 1

Dosing Frequency

• The daily dose may be administered in divided doses twice daily 1
• Once-daily administration has shown efficacy in mild persistent asthma in young children 2

Special Clinical Scenarios

For Croup

• For laryngotracheobronchitis (croup), budesonide can be administered at a dose of 2 mg as a single nebulized dose 3, 4

For Chronic Lung Disease of Infancy

• For infants with chronic lung disease of infancy (CLDI), inhaled budesonide has been used to reduce symptoms and improve lung function 1
• Nebulized budesonide is preferred over systemic corticosteroids to minimize side effects in CLDI 1

Safety Considerations

Monitoring

• Monitor for potential steroid side effects, including delayed growth, increased blood pressure, adrenal suppression, and cataracts 1
• These side effects are seen much less frequently with inhaled versus systemic corticosteroids 1
• Watch for oral candidiasis, which can be prevented by rinsing the infant's mouth after inhaled corticosteroid use 1

Pharmacokinetics

• In children 3-6 years of age, the systemic availability of budesonide after nebulization is approximately 6% of the labeled dose 5
• The terminal elimination half-life is approximately 2.3 hours in young children 5

Efficacy

• Budesonide inhalation suspension significantly improves day and night-time symptom scores in infants with persistent asthma compared to placebo 3
• It reduces the need for rescue medications in infants with persistent asthma 3, 2
• At a dosage of 2 mg/day, budesonide inhalation suspension significantly reduces the number of asthma exacerbations and requirements for systemic corticosteroids in preschool children with severe persistent asthma 3

Common Pitfalls

• The safety and efficacy of inhaled corticosteroids in children <1 year has not been firmly established, so careful monitoring is required 1
• Using ultrasonic nebulizers instead of jet nebulizers will result in ineffective delivery of the medication 1
• Failure to wash the face after treatment may increase the risk of local side effects 1