#13 Efficacy and safety of pulmonary application of corticosteroids in preterm infants with respiratory distress syndrome: A systematic review and meta-analysis
Mahin Delara, CHRIM/ University of Manitoba; Bhupendrasinh Chauhan, University of Manitoba; Mê-Linh Le, University of Manitoba; Ahmed M Abou-Setta, University of Manitoba; Ryan Zarychanski, University of MAnitoba; Geert W ‘t Jong, University of Manitoba
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 BPD without these side effects. This study was conducted to evaluate the efficacy and safety of pulmonary application of corticosteroids in preterm infants with RDS.
MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization’s International Clinical Trials Registry were searched with no restriction on date and language of publication. Randomized controlled trials (RCTs) comparing inhaled or endotracheal corticosteroids with the standard of care, placebo or no other intervention in preterm infants with RDS were identified. The primary outcomes were the incidence of BPD and all-cause mortality reported at the longest follow-up.
We identified 873 potential citations and included 12 unique RCTs. The gestational age of infants ranged from 26 to 34 weeks; birth weight ranged from 801 to 1591 grams. Pulmonary corticosteroid therapy was associated with a significant reduction in BPD (Relative risk (RR) 0.72, 95% CI 0.61 to 0.85; I2 21%; 7 trials; 1525 infants), but with no evidence of a demonstrable effect on short-term mortality. Pulmonary application of corticosteroids significantly reduced the incidence of patent ductus arteriosus (RR 0.62, 95% CI 0.46 to 0.84; I2 31%; 5 trials; 1317 infants) and pneumonia (RR 0.53, 95% CI 0.33 to 0.86; I2 0%; 3 trials; 324 infants). There was no evidence of a significant difference regarding the risk of neurodevelopmental impairment or other side effects.
Pulmonary administration of corticosteroids reduces the incidence of BPD, pneumonia, patent ductus arteriosus with no effect on mortality or causing any major side effects in preterm infants with RDS.