Efficacy and safety of pulmonary application of corticosteroids in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis

被引:22
作者
Delara, Mahin [1 ,2 ]
Chauhan, Bhupendrasinh F. [1 ,3 ,4 ]
Me-Linh Le [5 ]
Abou-Setta, Ahmed M. [6 ,7 ]
Zarychanski, Ryan [6 ,7 ,8 ,9 ]
'tJong, Geert W. [1 ,10 ]
机构
[1] Childrens Hosp Res Inst Manitoba, Clin Res Unit, Winnipeg, MB R3E 3P4, Canada
[2] Univ Manitoba, Coll Human Ecol, Fac Hlth Sci, Winnipeg, MB, Canada
[3] Univ Manitoba, Fac Hlth Sci, Coll Pharm, Winnipeg, MB, Canada
[4] Soham Res Grp Inc, Winnipeg, MB, Canada
[5] Univ Manitoba, Neil John Maclean Hlth Sci Lib, Winnipeg, MB, Canada
[6] Univ Manitoba, George & Fay Yee Ctr Healthcare Innovat, Winnipeg Reg Hlth Author, Winnipeg, MB, Canada
[7] Univ Manitoba, Dept Community Hlth Sci, Winnipeg, MB, Canada
[8] Univ Manitoba, Dept Internal Med, Sect Crit Care, Winnipeg, MB, Canada
[9] Canc Care Manitoba, Dept Haematol & Med Oncol, Winnipeg, MB, Canada
[10] Univ Manitoba, Dept Pediat, Max Rady Coll Med, Rady Fac Hlth Sci, Winnipeg, MB, Canada
来源
ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION | 2019年 / 104卷 / 02期
基金
加拿大健康研究院;
关键词
CHRONIC LUNG-DISEASE; BIRTH-WEIGHT INFANTS; BRONCHOPULMONARY DYSPLASIA; INTRATRACHEAL INSTILLATION; EXOGENOUS SURFACTANT; CHILDREN BORN; BUDESONIDE; PREMATURITY; PREVENTION; MANAGEMENT;
D O I
10.1136/archdischild-2017-314046
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background Systemic corticosteroids as the frontline treatment of respiratory distress syndrome (RDS) in preterm infants are associated with adverse effects on growth and neurodevelopmental outcome, but the pulmonary administration of steroids may help prevent the development of bronchopulmonary dysplasia (BPD) without these side effects. Objectives To evaluate the efficacy and safety of pulmonary application of corticosteroids in preterm infants with RDS. Methods MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the WHO's International Clinical Trials Registry and grey literature were searched with no restriction on date and language of publication from inception to May 2016. Using a random-effect model, we pooled data from randomised controlled trials (RCTs) comparing inhaled or endotracheal corticosteroids with the standard of care, placebo or no other intervention in preterm infants with RDS. Results We identified 873 potential citations and included 12 unique RCTs. Pulmonary corticosteroid therapy was associated with a significant reduction in the composite outcome of BPD or death (relative risk (RR) 0.85, 95% CI 0.76 to 0.96). Pulmonary application of corticosteroids significantly reduced the incidence of patent ductus arteriosus (PDA) (RR 0.82, 95% CI 0.74 to 0.92) and pneumonia (RR 0.57, 95% CI 0.35 to 0.92). There was no evidence of a significant difference regarding the risk of neurodevelopmental impairment or other side effects. Conclusions Pulmonary administration of corticosteroids reduces the incidence of BPD or death, pneumonia, PDA without causing any major side effects in preterm infants with RDS.
引用
收藏
页码:F137 / F144
页数:8
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