Can an Inhaled Medicine Help Premature Babies Come Off Breathing Support Sooner?

A plain-language look at a 2026 trial testing two inhaled steroids, budesonide and beclomethasone, in very premature babies at risk of chronic lung disease

For a very premature baby whose lungs are still developing, breathing support can go on for weeks, and many of these babies go on to develop a chronic lung condition called bronchopulmonary dysplasia, or BPD. A new study asked whether adding a breathed-in (inhaled) steroid medicine, given as a fine mist, could help these babies get off breathing support faster and leave the hospital sooner. The answer was encouraging but partial: the babies who received the inhaled steroid needed breathing support for about a week less and went home about a week and a half sooner, with no obvious added risks in the short term — although the medicine did not clearly prevent BPD itself.

This article looks at that clinical trial, published in 2026, which compared two inhaled steroid medicines against an inactive saline mist [1]. To understand why the question matters, it helps to know what BPD is and why doctors have wrestled with how to treat it for decades.

Why This Problem Has Been So Hard

When a baby is born many weeks early, the lungs are still unfinished. Machines that help with breathing, the extra oxygen babies need, infection, and poor nutrition can all injure these delicate lungs, and the result is often BPD — a chronic lung condition that can mean longer hospital stays, oxygen at home, and breathing problems that last well beyond infancy [2]. BPD is not rare. In China, it is the most common serious complication of very premature babies, affecting nearly 3 in 10 [3], and in the United States a large study found a similar rate, about 1 in 4 [4]. Despite big improvements in newborn care, those numbers have barely budged.

Because inflammation — the body's own overactive response to injury — is a major driver of lung damage in BPD, doctors have long used steroid medicines, which calm inflammation. For years, a steroid called dexamethasone was given through the bloodstream, early and often. But follow-up of those babies revealed a troubling trade-off: the medicine that helped the lungs could harm the developing brain, raising the risk of cerebral palsy and developmental problems [5]. Doctors responded by becoming far more selective, reserving steroids given through the bloodstream for the babies at highest risk, where the benefit is most likely to outweigh the harm [6]. Large reviews of all the evidence confirmed that steroids do reduce BPD but left open the crucial practical questions of which steroid, given how, when, and to whom [7].

This is where inhaled steroids enter the story. The idea is appealing: if the medicine is breathed straight into the lungs as a mist, it can act where it is needed while very little reaches the rest of the body, potentially helping the lungs without the same risk to the brain [8]. An earlier, much larger study tested one inhaled steroid, budesonide, started within the first day of life; it did lower BPD, but hinted at a possible small increase in deaths, which left doctors cautious [9]. Other reviews found that inhaled budesonide and beclomethasone (but not a third steroid, fluticasone) shortened the time babies needed oxygen [10]. The new trial was designed to test a safer-seeming approach: waiting until after the first week, and only treating babies who had already shown they were struggling.

What the Researchers Did

The study took place in the newborn intensive care unit of Xuzhou Central Hospital in China, with babies admitted between October 2024 and November 2025 [1]. The researchers focused on very premature babies — born before 32 weeks and weighing less than 1,500 grams (about 3 pounds 5 ounces) — who were more than a week old, still needed gentle breathing support, and had at least one warning sign for BPD. In other words, they chose exactly the babies a care team would already be worried about.

A total of 118 babies were divided by chance into three groups. One group breathed in a plain saltwater mist (the comparison group), one breathed in budesonide, and one breathed in beclomethasone, each given as a mist every 12 hours until the baby no longer needed breathing support. Crucially, all three groups received the same excellent standard care — good nutrition including vitamin A, careful fluid and oxygen management, gentle ventilation, the stimulant caffeine, and infection prevention — so the inhaled steroid was an extra layer on top of solid care, not a replacement for it. The main thing the researchers measured was how long each baby needed breathing support [1].

What They Found

The babies who received either inhaled steroid needed breathing support for a meaningfully shorter time: about 36 days on average, compared with about 43 days in the saltwater group. They also left the hospital sooner — roughly 40 days versus 50 days [1]. For a family, a week and a half less in the hospital is real: less time apart, lower cost, and an earlier start to life at home. The two steroid medicines worked about equally well, so there was no clear winner between budesonide and beclomethasone.

The more cautious part of the story is that the medicines did not clearly prevent BPD. Fewer babies in the steroid groups developed BPD (about 28–29%, versus 51% in the comparison group), but the difference was not quite strong enough to rule out chance in a study this size [1]. The researchers were honest that a study large enough to answer the BPD question directly would need several hundred babies per group, far more than a single hospital could enroll. The steroids also did not change the babies' oxygen needs in the first two days, suggesting the benefit builds slowly rather than working overnight. Blood tests offered a clue as to why: after two weeks, babies on the steroids had lower levels of an inflammation-promoting signal and higher levels of a calming one — a sign the medicines were quieting lung inflammation [11]. Reassuringly, there were no deaths and no increase in problems such as serious infection, bowel injury, brain bleeds, or eye disease in the short term.

What This Means for Families

If your baby is very premature and struggling to come off breathing support, this study is modest good news: adding an inhaled steroid after the first week, on top of strong routine care, may help the lungs settle faster and bring discharge closer, and it appeared safe over the length of the hospital stay. It is equally important to understand what the study does not promise. It does not show that the medicine prevents chronic lung disease, and — most importantly — it did not follow the babies long enough to know how they do as they grow. Because the biggest historical worry about steroids in premature babies has always been the developing brain [6], the research team is now following these same babies to check their long-term breathing, growth, and development. Those results will be essential before anyone can say the short-term benefit is truly worth it.

It also helps to understand why doctors cannot simply give the medicine to every premature baby to be safe. Steroids are powerful, and giving them to babies who would have done well anyway exposes them to possible risks for no benefit — which is exactly the lesson learned when the older, bloodstream steroids were used too freely in the past. That is why this trial, like modern practice, focused on the babies most likely to need the extra help. It is a careful, targeted approach rather than a blanket one, and it reflects hard-won caution rather than hesitation.

Parents should also know that the two medicines are not identical in the laboratory, even though they performed similarly here, and doctors are still working out the best drug, dose, and timing for different babies [12]. If your care team suggests an inhaled steroid, it is fair to ask why they think your baby is a good candidate, what they hope it will achieve (usually a shorter time on support rather than a guarantee against lung disease), and how your baby's development will be monitored afterward.

What Comes Next

Researchers are now working to answer the questions this small trial could not: whether inhaled steroids genuinely reduce chronic lung disease, which babies benefit most, and — above all — whether these babies grow and develop normally. Larger studies across many hospitals, following children for years rather than weeks, will be needed to turn this promising early signal into confident, lasting advice for families. For now, the finding stands as a careful, hopeful step: a familiar medicine, given a gentler way, that may ease one of the hardest stretches of a premature baby's first months.

References

  1. Gao X, et al. Inhaled budesonide and beclomethasone for the prevention and treatment of bronchopulmonary dysplasia in very preterm infants: a prospective randomized controlled trial. Front Pediatr. 2026;14:1818492. doi:10.3389/fped.2026.1818492 ↩
  2. Ambalavanan N, Deutsch G, Pryhuber G, Travers CP, Willis KA. The evolving pathophysiology of bronchopulmonary dysplasia. Physiol Rev. 2026;106(1):197–237. doi:10.1152/physrev.00042.2024 ↩
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  8. Rüegger CM, Bassler D. Alternatives to systemic postnatal corticosteroids: inhaled, nebulized and intratracheal. Semin Fetal Neonatal Med. 2019;24(3):207–12. doi:10.1016/j.siny.2019.04.006 ↩
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