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Inhaled Corticosteroids for Bronchopulmonary Dysplasia: A Meta-analysis


Shinwell, Eric S; Portnov, Igor; Meerpohl, Joerg J; Karen, Tanja; Bassler, Dirk (2016). Inhaled Corticosteroids for Bronchopulmonary Dysplasia: A Meta-analysis. Pediatrics, 138(6):e20162511.

Abstract

CONTEXT Bronchopulmonary dysplasia (BPD) in preterm infants remains a major health burden despite many therapeutic interventions. Inhaled corticosteroids (IC) may be a safe and effective therapy. OBJECTIVE To assess the safety and efficacy of IC for prevention or treatment of BPD or death in preterm infants. DATA SOURCES PubMed, the Cochrane Library, Embase, and CINAHL from their inception until November 2015 together with other relevant sources. STUDY SELECTION Randomized controlled trials of ICs versus placebo for either prevention or treatment of BPD. DATA EXTRACTION This meta-analysis used a random-effects model with assessment of quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS Thirty-eight trials were identified, and 16 met inclusion criteria. ICs were associated with a significant reduction in death or BPD at 36 weeks' postmenstrual age (risk ratio [RR] = 0.86, 95% confidence interval [CI] 0.75 to 0.99, I(2) = 0%, P = .03; 6 trials, n = 1285). BPD was significantly reduced (RR = 0.77, 95% CI 0.65 to 0.91, I(2) = 0%, 7 trials, n = 1168), although there was no effect on death (RR = 0.97, 95% CI 0.42 to 2.2, I(2) = 50%, 7 trials, n = 1270). No difference was found for death or BPD at 28 days' postnatal age. The use of systemic steroids was significantly reduced in treated infants (13 trials, n = 1537, RR = 0.87, 95% CI 0.76 to 0.98 I(2) = 3%,). No significant differences were found in neonatal morbidities and other adverse events. LIMITATIONS Long-term follow-up data are awaited from a recent large randomized controlled trial. CONCLUSIONS Very preterm infants appear to benefit from ICs with reduced risk for BPD and no effect on death, other morbidities, or adverse events. Data on long-term respiratory, growth, and developmental outcomes are eagerly awaited.

Abstract

CONTEXT Bronchopulmonary dysplasia (BPD) in preterm infants remains a major health burden despite many therapeutic interventions. Inhaled corticosteroids (IC) may be a safe and effective therapy. OBJECTIVE To assess the safety and efficacy of IC for prevention or treatment of BPD or death in preterm infants. DATA SOURCES PubMed, the Cochrane Library, Embase, and CINAHL from their inception until November 2015 together with other relevant sources. STUDY SELECTION Randomized controlled trials of ICs versus placebo for either prevention or treatment of BPD. DATA EXTRACTION This meta-analysis used a random-effects model with assessment of quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS Thirty-eight trials were identified, and 16 met inclusion criteria. ICs were associated with a significant reduction in death or BPD at 36 weeks' postmenstrual age (risk ratio [RR] = 0.86, 95% confidence interval [CI] 0.75 to 0.99, I(2) = 0%, P = .03; 6 trials, n = 1285). BPD was significantly reduced (RR = 0.77, 95% CI 0.65 to 0.91, I(2) = 0%, 7 trials, n = 1168), although there was no effect on death (RR = 0.97, 95% CI 0.42 to 2.2, I(2) = 50%, 7 trials, n = 1270). No difference was found for death or BPD at 28 days' postnatal age. The use of systemic steroids was significantly reduced in treated infants (13 trials, n = 1537, RR = 0.87, 95% CI 0.76 to 0.98 I(2) = 3%,). No significant differences were found in neonatal morbidities and other adverse events. LIMITATIONS Long-term follow-up data are awaited from a recent large randomized controlled trial. CONCLUSIONS Very preterm infants appear to benefit from ICs with reduced risk for BPD and no effect on death, other morbidities, or adverse events. Data on long-term respiratory, growth, and developmental outcomes are eagerly awaited.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neonatology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:December 2016
Deposited On:30 Dec 2016 07:04
Last Modified:22 Jan 2017 06:03
Publisher:American Academy of Pediatrics
ISSN:0031-4005
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1542/peds.2016-2511
PubMed ID:27940717

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