Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University), Ministry of Education, Chengdu, China.
Arch Dis Child Fetal Neonatal Ed. 2018 Nov;103(6):F506-F511. doi: 10.1136/archdischild-2017-313759. Epub 2018 Feb 23.
To determine the comparative efficacy and safety of corticosteroids in the prevention of bronchopulmonary dysplasia (BPD) in preterm infants.
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.
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).
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.
评估皮质类固醇在预防早产儿支气管肺发育不良（BPD）中的疗效和安全性。
我们系统地检索了 PubMed、EMBASE 和 Cochrane 图书馆。两位审查员独立选择了皮质类固醇治疗早产儿的随机对照试验（RCT）。进行贝叶斯网络荟萃分析和亚组分析。
我们纳入了 47 项 RCT，共计 6747 名参与者。使用高剂量或低剂量地塞米松可降低 BPD 风险（OR 0.29，95%可信区间（CrI）0.14 至 0.52；OR 0.58，95%CrI 0.39 至 0.76）。高剂量地塞米松比氢化可的松、倍氯米松和低剂量地塞米松更有效。早期和长期使用高剂量或低剂量地塞米松均可降低 BPD 风险（OR 0.11，95%CrI 0.02 至 0.4；OR 0.37，95%CrI 0.16 至 0.67）。不同皮质类固醇之间脑瘫（CP）的风险无统计学差异。然而，高剂量和长期地塞米松在 CP 方面的排名低于安慰剂和其他方案。亚组分析表明，布地奈德可降低极早产儿和极低出生体重儿的 BPD 风险（OR 0.60，95%CrI 0.36 至 0.93）。
地塞米松可降低早产儿 BPD 的风险。在不同的地塞米松方案中，积极的起始治疗似乎有益，而避免高剂量和长期联合使用可能会导致不良的神经发育结局。需要进一步在大型 RCT 中进行地塞米松和吸入性皮质类固醇的研究，并进行长期随访。
