Source:

Ramaswamy
VV
,
Bandyopadhyay
T
,
Nanda
D
, et al
.
Assessment of postnatal corticosteroids for the prevention of bronchopulmonary dysplasia in preterm neonates: a systematic review and network meta-analysis [Published online March 15, 2021]
.
JAMA Pediatr
. doi:
https://doi.org/10.1001/jamapediatrics.2020.6826

Investigators from multiple institutions conducted a systematic review and meta-analysis to evaluate and compare postnatal corticosteroid (PNC) treatment regimens in the prevention of bronchopulmonary dysplasia (BPD) in preterm infants. Investigators searched several online databases (eg, MEDLINE) from inception until 2020 for randomized controlled trials that involved preterm neonates with a gestational age of ≤32 weeks and evaluated the effects of any one of 14 PNCs on BPD and mortality. The 14 PNC interventions included were: (1) moderately early initiated (8-14 days), low cumulative dose (<2 mg/kg) of systemic dexamethasone (MoLdDX); (2) moderately early initiated, medium cumulative dose (2-4 mg/kg) of systemic dexamethasone (MoMdDX); (3) moderately early initiated, high cumulative dose (>4 mg/kg) of systemic dexamethasone (MoHdDX); (4) late-initiated (15-27 days), low cumulative dose of systemic dexamethasone (LaLdDX); (5) late-initiated, medium cumulative dose of systemic dexamethasone (LaMdDX); (6) late-initiated, high cumulative dose of systemic dexamethasone (LaHdDX); (7) early initiated (<8 days) systemic hydrocortisone (EHC); (8) late-initiated (≥8 days) systemic hydrocortisone (LHC); (9) early initiated (<8 days) inhaled budesonide (EIBUD); (10) early initiated inhaled beclomethasone (EIBEC); (11) early initiated inhaled fluticasone (EIFLUT); (12) late-initiated (≥8 days) inhaled budesonide (LIBUD); (13) late-initiated inhaled beclomethasone (LIBEC); and (14) intratracheal budesonide (ITBUD).

The primary outcome was mortality or BPD. BPD was defined as oxygen dependency at a postmenstrual age of 36 weeks. Secondary outcomes included hypertension, gastrointestinal perforation, and neurodevelopmental impairment (NDI). Investigators conducted a pooled analysis to estimate the risk ratio (RR) for the primary and secondary outcomes among different PNC interventions.

There were 45 studies involving 5,236 neonates included in the meta-analysis. There were 6 PNC interventions associated with a reduced risk of mortality or BPD: EHC (RR, 0.82; 95% CI, 0.68, 0.97); EIFLUT (RR, 0.75; 95% CI, 0.55, 0.98); LaHdDX (RR, 0.70; 95% CI, 0.54,0.87); MoHdDX (RR, 0.64; 95% CI, 0.48, 0.82); ITBUD (RR, 0.73; 95% CI, 0.57, 0.91); and MoMdDX (RR, 0.61; 95% CI, 0.45, 0.79). No PNC was associated with NDI, but EHC was associated with increased risk of gastrointestinal perforation, and MoMdDx was associated with higher risk of hypertension.

The authors conclude that MoMdDx was associated with the greatest reduction in risk of mortality or BPD, though it also was associated with a higher risk of hypertension.

Dr Mintzer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

The use of postnatal corticosteroids for the prevention of BPD in premature neonates remains a highly controversial aspect of neonatal care.1,2  While some neonates with clinically significant oxygen and respiratory requirements benefit...

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