Use of mucolytics and inhaled antibiotics in the NICU.

Clearance of airway secretions and treatment of respiratory tract infections (RTIs) are two common problems caregivers face in the neonatal intensive care unit (NICU). Mucolytics degrade crosslinks in mucus gel, reducing mucus viscosity and facilitating their removal by cough or endotracheal suctioning. While such medications have been studied in older children and adults, their use is not as well described in the NICU. For RTIs, systemic antibiotics are usually prescribed, although their use is often associated with adverse effects. Inhaled antibiotics may provide increased drug concentrations to the infected airways while minimizing systemic toxicity. The use of inhaled antibiotics in the NICU has been described in small case series. As underlying physiologic differences will lend to inaccuracies when extrapolating data obtained from older children, there is an urgent need to determine the safety, efficacy, and optimal dosing of inhaled mucolytics and antibiotics in infants of varying gestational and post-natal ages.