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Aerosol delivery to non‐ventilated infants by metered dose inhaler: Should a valved spacer be used?

In a randomized double‐blind cross‐over study on 20 spontaneously breathing, oxygen‐dependent preterm infants who had received positive pressure ventilation for respiratory distress syndrome, we tested the hypothesis that the one‐way non‐rebreathing valves of aerosol spacer devices might impair rather than enhance the delivery of aerosols to small infants by metered dose inhalers (MDI). Ten infants were given 2 doses (200 μg/dose) of MDI albuterol through a neonatal Aerochamber® 4 h apart. At random sequence, one dose was delivered with the non‐rebreathing valve of the Aerochamber® in place; for the other dose, the valve had been removed. The experiment was repeated on another ten infants using a different spacer device (Babyhaler®) with or without its one‐way inspiratory valve removed.