Abstract
BackgroundUncertainly prevails with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants. The meta-analysis with sequential analysis was designed to evaluate the efficacy and safety of airway administration (inhalation or instillation) of corticosteroids for preventing bronchopulmonary dysplasia (BPD) in premature infants.MethodsWe searched MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL from their inceptions to February 2017. All published randomized controlled trials (RCTs) evaluating the effect of airway administration of corticosteroids (AACs) vs placebo or systemic corticosteroid in prematurity were included. All meta-analyses were performed using Review Manager 5.3.ResultsTwenty five RCTs retrieved (n = 3249) were eligible for further analysis. Meta-analysis and trial sequential analysis corrected the 95% confidence intervals estimated a lower risk of the primary outcome of BPD (relative risk 0.71, adjusted 95% confidence interval 0.57–0.87) and death or BPD (relative risk 0.81, adjusted 95% confidence interval 0.71–0.97) in AACs group than placebo and it is equivalent for preventing BPD than systemic corticosteroids. Moreover, AACs fail to increasing risk of death compared with placebo (relative risk 0.90, adjusted 95% confidence interval 0.40–2.03) or systemic corticosteroids (relative risk 0.81, 95% confidence interval 0.62–1.06).ConclusionsOur findings suggests that AACs (especially instillation of budesonide using surfactant as a vehicle) are an effective and safe option for preventing BPD in preterm infants. Furthermore, the appropriate dose and duration, inhalation or instillation with surfactant as a vehicle and the long-term safety of airway administration of corticosteroids needs to be assessed in large trials.
Highlights
Prevails with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants
Study selection Our search identified 121 potentially relevant articles during the initial electronic database search, of which 35 randomized controlled trials (RCTs) were involving the use of administration of corticosteroids (AACs) in premature infants
The target population in each studies may be very. In this meta-analysis with sequential analysis, compared with placebo, AACs was found to reduce the risk of bronchopulmonary dysplasia (BPD) and death or BPD, with no assocaited increase in mortality and neurodevelopmental impairment
Summary
Prevails with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants. The meta-analysis with sequential analysis was designed to evaluate the efficacy and safety of airway administration (inhalation or instillation) of corticosteroids for preventing bronchopulmonary dysplasia (BPD) in premature infants. A metaanalysis including the RCT by Bassler D et al [17] showed that inhaled corticosteroids reduced risk for BPD and had no effect on death. Their meta-analysis included several therapeutic studies and failed to evaluate the intratracheal instillation of steroids [18, 19]. Most of the main outcome were concluded from a small number of the studies with few infants providing data [21, 22]
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