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Arch Dis Child Fetal Neonatal Ed. 2019 Mar;104(2):F137-F144. doi: 10.1136/archdischild-2017-314046. Epub 2018 Apr 17.

Efficacy and safety of pulmonary application of corticosteroids in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis.

Author information

1
Clinical Research Unit, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
2
College of Human Ecology, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
3
College of Pharmacy, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
4
Soham Research Group Inc, Winnipeg, Manitoba, Canada.
5
Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada.
6
George & Fay Yee Centre for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada.
7
Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
8
Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada.
9
Department of Haematology and Medical Oncology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada.
10
Department of Pediatrics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

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.

KEYWORDS:

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

[Indexed for MEDLINE]

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