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Corticosteroids for the prevention of bronchopulmonary dysplasia in preterm infants: a network meta-analysis
  1. Linan Zeng1,2,
  2. Jinhui Tian3,4,
  3. Fujian Song5,
  4. Wenrui Li1,6,
  5. Lucan Jiang1,6,
  6. Ge Gui1,6,
  7. Yang Zhang1,6,
  8. Long Ge3,
  9. Jing Shi2,7,
  10. Xin Sun8,
  11. Dezhi Mu2,7,
  12. Lingli Zhang1,2
  1. 1 Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
  2. 2 Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University), Ministry of Education, Chengdu, China
  3. 3 Evidence Based Medicine Center, Lanzhou University, Lanzhou, China
  4. 4 Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, China
  5. 5 Norwich Medical School, University of East Anglia, Norwich, UK
  6. 6 West China School of Pharmacy, Sichuan University, Chengdu, China
  7. 7 Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
  8. 8 Chinese Evidence-Based Medicine Center/Chinese Cochrane Center, West China Hospital, Sichuan University, Chengdu, China
  1. Correspondence to Professor Lingli Zhang, Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; zhanglingli{at}scu.edu.cn

Abstract

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
  • corticosteroid
  • network meta-analysis

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Footnotes

  • 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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