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Efficacy and safety of pulmonary application of corticosteroids in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis
  1. Mahin Delara1,2,
  2. Bhupendrasinh F Chauhan1,3,4,
  3. Mê-Linh Le5,
  4. Ahmed M Abou-Setta6,7,
  5. Ryan Zarychanski6,7,8,9,
  6. Geert W ’tJong1,10
  1. 1Clinical Research Unit, Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
  2. 2College of Human Ecology, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  3. 3College of Pharmacy, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  4. 4Soham Research Group Inc, Winnipeg, Manitoba, Canada
  5. 5Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
  6. 6George & Fay Yee Centre for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
  7. 7Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  8. 8Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada
  9. 9Department of Haematology and Medical Oncology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
  10. 10Department of Pediatrics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  1. Correspondence to Professor Geert W ’tJong, Clinical Research Unit, Children’s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada; geert.tjong{at}umanitoba.ca

Abstract

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.

  • bronchopulmonary dysplasia
  • corticosteroid
  • preterm infants
  • pulmonary application
  • respiratory distress syndrome

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Footnotes

  • Contributors GWt' proposed the topic. MD and M-LL designed the search strategy. MD, GWt’J and BFC reviewed the citations and extracted the data. AMA-S and RZ checked the methodology. MD analysed the data and prepared the first draft of the manuscript. All authors were involved in revising the manuscript and approved the final version.

  • Funding No funding was specifically obtained for this systematic review.

  • Competing interests MD’s salary is supported by GW’tJ’s Establishment Grant from the University of Manitoba and the Children’s Hospital Research Foundation of Manitoba. RZ is the recipient of a Canadian Institutes of Health Research (CIHR) New Investigator salary award.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at This research was presented in the 33rd International Conference on Pharmacoepidemiology and Therapeutic Risk Management, Montreal, Canada, 26–30 August 2017. MD also received poster award in the 13th Annual Child Health Research Days, Winnipeg, Canada, 3–5 October 2017.

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