Corticosteroids for the prevention of bronchopulmonary dysplasia in preterm infants: a network meta-analysis

Linan Zeng, Jinhui Tian, Fujian Song, Wenrui Li, Lucan Jiang, Ge Gui, Yang Zhang, Long Ge, Jing Shi, Xin Sun, Dezhi Mu, Lingli Zhang, Linan Zeng, Jinhui Tian, Fujian Song, Wenrui Li, Lucan Jiang, Ge Gui, Yang Zhang, Long Ge, Jing Shi, Xin Sun, Dezhi Mu, Lingli Zhang

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.

Keywords: bronchopulmonary dysplasia; corticosteroid; network meta-analysis.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Network of corticosteroids for the prevention of bronchopulmonary dysplasia at 36 weeks’ postmenstrual age. The circle size reflects the number of participants, and the line width reflects the number of direct comparisons. No connecting line between two treatments indicates that there was no direct comparison.

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