Long‐term effects of the intratracheal administration of corticosteroids for the prevention of bronchopulmonary dysplasia: A meta‐analysis

Abstract

Background Bronchopulmonary dysplasia (BPD) is one of the most common complications in premature infants. Since inflammation plays a crucial role in the pathogenesis of BPD, anti‐inflammatory drugs, such as corticosteroids, have long been the focus of prevention research. In this meta‐analysis, we aim to explore the long‐term effects of the intratracheal administration of corticosteroids (IAC) in preventing BPD. Methods EMBASE, MEDLINE, the Cochrane Library, Web of Science, CINAHL, Clinicaltrials.gov, the ISRCTN registry, and gray literature were searched to identify randomized controlled trials (RCTs) that evaluated the long‐term effects of IAC for the prevention of BPD in premature infants. Results Five RCTs (n = 1515) were eligible for further analysis. The meta‐analysis revealed that the incidence of neurodevelopmental impairment (NDI) did not significantly differ between the IAC group and the control group (relative risk [RR] 0.9, 95% confidence interval [CI] 0.79 to 1.03, P = .14). There was no significant reduction in long‐term mortality (RR, 1.13; 95% CI, 0.9 to 1.41; P = .3) or the incidence of rehospitalization (RR, 0.99; 95% CI, 0.89 to 1.09, P = .82). No significant differences were observed between the IAC group and the control group with regard to height, weight and head circumference at the age of 18 to 36 months of postmenstrual age (PMA) (mean difference [MD], 0.14; 95% CI, −0.26 to 0.54, P = .48). Conclusions Our study suggests that IAC in preterm infants does not have significant long‐term benefits or adverse outcomes. However, before routine use, well‐designed studies and studies involving large sample sizes are needed to confirm the pharmacokinetics and long‐term effects of IAC.

The role of red cell distribution width as a predictor of bronchopulmonary dysplasia in preterm infants

“…In recent years, due to advances in neonatology, especially in preterm infants, viability rates have increased despite low gestational weeks and birth weights, which has brought with it an increased incidence of morbidities, such as BPD [4] . Therefore, early detection of premature infants, which may be riskier for BPD, has become very important for clinicians, so clinical investigations have been conducted in recent years with many costly and difficult to access markers [15][16][17] .…”

“…The incidence of BPD has markedly increased with decreased gestational week and low birth weight, and in preterm infants born below 1500 gr, BPD may have an incidence rate of 30-40% [2,3] . Although many factors, such as immature lungs, barotrauma due to mechanical ventilation, oxidative stress and inflammation, lead to the development of BPD, especially inflammation plays a critical role in the pathogenesis of BPD [4,5] . struction may alter the size of the erythrocytes, causing a change in RDW.…”

Corticosteroids in the prevention and treatment of infants with bronchopulmonary dysplasia: Part II. Inhaled corticosteroids alone or in combination with surfactants

“…However, these two meta‐analyses 14,15 included trials with instillation of steroids in the trachea using surfactant as a vehicle, which (as will be separately reviewed below) appears to be more effective in reducing the incidence of BPD without increasing the mortality and the adverse effects. Another recent meta‐analysis including 1515 patients in five randomized clinical trials has shown that intratracheal administration of CSs did not result in significant long‐term (>18 months) benefits or adverse outcomes in preterm children, however, approximately a quarter of the patients received intratracheal surfactant, too 16 . This meta‐analysis could check long‐term mortality, incidence of rehospitalization, incidence of neurodevelopmental impairment, and growth parameters; but none of the included studies reported pulmonary function in terms of long‐term outcomes 16 .…”

“…16 This meta-analysis could check longterm mortality, incidence of rehospitalization, incidence of neurodevelopmental impairment, and growth parameters; but none of the included studies reported pulmonary function in terms of long-term outcomes. 16 Based on the aforementioned studies and metaanalyses the administration of aerosolized steroids alone for preventing or treating BPD remains unresolved. [7][8][9][10][11]13,17 However, the studies included showed high heterogeneity regarding the time when they were conducted, their quality of evidence (GRADE approach), the drug administrated, its dose and timing, the delivery techniques, and the reported short-term and long-term outcomes.…”

Pediatric Pulmonology 2019 year in review: Neonatal pulmonology

“…In furtherance of improved noninvasive support techniques, Sivieri et al 34 A long-sought but only partially achieved the goal of targeted drug delivery in newborns relies on effective nebulization. Attempts at rescue treatment of BPD with inhaled corticosteroids have had decidedly mixed results, 36 which may be attributable in part to inconsistent drug delivery. Ari et al 37 made a thorough examination of drug deposition using a model system that included newborn-and child-sized airways, using a variety of nebulizers, flow rates, and patient interfaces.…”