Department of Respiratory, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
School of Clinical Medicine, Chongqing Medical and Pharmaceutical College, Chongqing, China.
Pediatr Pulmonol. 2022 Feb;57(2):455-469. doi: 10.1002/ppul.25759. Epub 2021 Nov 25.
To address the effectiveness and safety of early airway combined utilization of budesonide and surfactant for bronchopulmonary dysplasia (BPD) prevention in premature infants with respiratory distress syndrome (RDS).
Literature retrieval was carried out in the PubMed, Web of Science, EMBASE, Cochrane Library, Wanfang, CQ VIP, and China National Knowledge Infrastructure databases, searching from the inception to September 2021. Stata 16.0 software was used for statistical analysis.
This meta-analysis suggested that early combined utilization of budesonide and surfactant by airway have a superiority on BPD incidence (risk ratio [RR] = 0.62; 95% confidence interval [CI]: 0.54-0.71, p < 0.001], mortality (RR = 0.64; 95%CI: 0.45-0.92, p = 0.016), the composite outcome of BPD or mortality (RR = 0.58; 95%CI: 0.50-0.68, p < 0.001), the additional doses of surfactant (RR = 0.53; 95%CI: 0.44-0.63, p < 0.001), the duration of assisted ventilation (standard mean difference [SMD] = -1.14; 95%CI: -1.58 to -0.70, p < 0.001), duration of invasive ventilation(SMD = -1.77; 95% CI: -2.61 to -0.93, p < 0.001), and hospital stays (SMD = -1.11; 95% CI: -1.73 to -0.49, p = 0.001) in preterm infants with RDS. And these benefits were not associated with increased adverse outcomes. Furthermore, a decreased incidence of patent ducts arterious (PDA) (RR = 0.79; 95% CI: 0.65 to 0.97, p = 0.028) was found in premature infants treated with budesonide and surfactant. Subgroup analysis based on budesonide delivery methods (inhalation or intratracheal instillation) indicated that the decrease of mortality (RR = 0.63; 95% CI: 0.43-0.93, p = 0.019), duration of assisted ventilation (SMD = -0.95; 95% CI: -1.30 to -0.61, p < 0.001), hospital stays (SMD = -1.23; 95% CI: -2.05 to -0.41, p = 0.003) and PDA incidence (RR = 0.80; 95% CI: 0.65 to 0.99, p = 0.044) were mainly in budesonide intratracheal instillation subgroup, rather than in budesonide inhalation subgroup.
This meta-analysis suggested that early combined utilization of budesonide and surfactant by airway might be an effective and safe clinical practice for BPD prevention in premature infants with RDS, especially when budesonide was delivered by intratracheal instillation. However, many of the included studies were small and were from Asian origin. More well-designed randomized controlled trials with larger sample sizes and longer follow-up from all over the world ought to be conducted in the future.
探讨早期联合应用布地奈德和表面活性物质预防呼吸窘迫综合征（RDS）早产儿支气管肺发育不良（BPD）的效果和安全性。
检索 PubMed、Web of Science、EMBASE、Cochrane 图书馆、万方、维普和中国知网数据库，检索时间从建库至 2021 年 9 月。采用 Stata 16.0 软件进行统计学分析。
本荟萃分析表明，早期经气道联合应用布地奈德和表面活性物质可降低 BPD 发生率（风险比[RR] = 0.62；95%置信区间[CI]：0.54-0.71，p<0.001）、死亡率（RR = 0.64；95%CI：0.45-0.92，p=0.016）、BPD 或死亡率复合结局（RR = 0.58；95%CI：0.50-0.68，p<0.001）、表面活性物质的附加剂量（RR = 0.53；95%CI：0.44-0.63，p<0.001）、辅助通气时间（标准均数差[SMD] = -1.14；95%CI：-1.58 至-0.70，p<0.001）、有创通气时间（SMD = -1.77；95%CI：-2.61 至-0.93，p<0.001）和住院时间（SMD = -1.11；95%CI：-1.73 至-0.49，p=0.001）。并且这些获益与增加不良结局无关。此外，布地奈德和表面活性物质治疗组早产儿的动脉导管未闭（PDA）发生率降低（RR = 0.79；95%CI：0.65 至 0.97，p=0.028）。基于布地奈德给药方法（吸入或气管内滴注）的亚组分析表明，死亡率（RR = 0.63；95%CI：0.43-0.93，p=0.019）、辅助通气时间（SMD = -0.95；95%CI：-1.30 至-0.61，p<0.001）、住院时间（SMD = -1.23；95%CI：-2.05 至-0.41，p=0.003）和 PDA 发生率（RR = 0.80；95%CI：0.65 至 0.99，p=0.044）主要见于布地奈德气管内滴注亚组，而非布地奈德吸入亚组。
本荟萃分析表明，早期经气道联合应用布地奈德和表面活性物质可能是预防 RDS 早产儿 BPD 的有效且安全的临床实践，尤其是当布地奈德通过气管内滴注给药时。然而，纳入的许多研究规模较小且来自亚洲。未来应该开展更多来自世界各地、设计更合理、样本量更大且随访时间更长的随机对照试验。
