Objective To determine the comparative efficacy and safety of corticosteroids in the prevention of bronchopulmonary dysplasia (BPD) in preterm infants.
Study design We systematically searched PubMed, EMBASE and the Cochrane Library. Two reviewers independently selected randomised controlled trials (RCTs) of postnatal corticosteroids in preterm infants. A Bayesian network meta-analysis and subgroup analyses were performed.
Results We included 47 RCTs with 6747 participants. The use of dexamethasone at either high dose or low dose decreased the risk of BPD (OR 0.29, 95% credible interval (CrI) 0.14 to 0.52; OR 0.58, 95% CrI 0.39 to 0.76, respectively). High-dose dexamethasone was more effective than hydrocortisone, beclomethasone and low-dose dexamethasone. Early and long-term dexamethasone at either high dose or low dose decreased the risk of BPD (OR 0.11, 95% CrI 0.02 to 0.4; OR 0.37, 95% CrI 0.16 to 0.67, respectively). There were no statistically significant differences in the risk of cerebral palsy (CP) between different corticosteroids. However, high-dose and long-term dexamethasone ranked lower than placebo and other regimens in terms of CP. Subgroup analyses indicated budesonide was associated with a decreased risk of BPD in extremely preterm and extremely low birthweight infants (OR 0.60, 95% CrI 0.36 to 0.93).
Conclusions Dexamethasone can reduce the risk of BPD in preterm infants. Of the different dexamethasone regimens, aggressive initiation seems beneficial, while a combination of high-dose and long-term use should be avoided because of the possible adverse neurodevelopmental outcome. Dexamethasone and inhaled corticosteroids need to be further evaluated in large-scale RCTs with long-term follow-ups.
- bronchopulmonary dysplasia
- network meta-analysis
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Contributors LZe conceived the study, drafted the study protocol, analysed the data, and drafted and revised the manuscript. JT revised the study protocol, and analysed and interpreted the data. FS contributed to the conception and design of the study, analysed and interpreted the data, and revised the manuscript. WL and LJ selected the articles, extracted data and analysed the data. GG and YZ extracted data and assessed the risk of bias of included studies. LG analysed and interpreted the data, and revised the manuscript. JS contributed to the conception and design of the study, revised the study protocol and interpreted the data. XS revised the study protocol, interpreted the data and revised the manuscript. DM contributed to the conception and design of the study and revised the manuscript. LZa conceived the study, interpreted the data, and drafted and revised the study protocol and manuscript.
Funding This study was funded by the National Natural Science Foundation for Young Scholars of China (no 71503177) and the National Natural Science Foundation of China (no 81373381).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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