Inhaled Ciclesonide Study in Preterm Infants

Inclusion Criteria:

* Viable Infants born between 23 0/7 - 29 6/7 gestation
* Requiring invasive (through an endotracheal tube) mechanical ventilation
* Between day of life 8 to 35.
* Infants have not received dexamethasone for 120 hours
* If receiving hydrocortisone, then receiving ≤ 1mg/kg/day

Exclusion Criteria:

* Infants with major congenital lung or other organ anomalies, life-threatening illness, active sepsis or NEC, and grade IV hemorrhage will be excluded.
* Infants receiving DEX therapy will be excluded.
* We will exclude infants who have had ≥ 1 glucose level \> 150mg in the 24 hours prior to study entry or those on insulin therapy to treat hyperglycemia. We will exclude infants who have hypertension (\>95% centile for gestational age) in the 48 hours prior to study entry.
* For small for gestational age, we will exclude infants with a birthweight \< 5% centile for gestational age.
* Infants with history of recent pulmonary hemorrhage (within 72 hours of study entry) will also be excluded.
* Infants receiving or have received any dexamethasone in the prior 120 hours.
* Infants receiving \>1mg/kg/day of hydrocortisone.
* Infants receiving any other inhaled or systemic steroid.