Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok 10210, Thailand.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada.
Medicina (Kaunas). 2021 Nov 21;57(11):1281. doi: 10.3390/medicina57111281.
: Meconium aspiration syndrome (MAS) is a condition caused by the aspiration of meconium-stainted amniotic fluid into the lungs, resulting in pulmonary inflammation, neonatal morbidity, and mortality. It is important that these MAS infants receive appropriate care to avoid further complications. Steroids have an anti-inflammatory effect and may be effective in the management of MAS. The objective of the this study was to evaluate the effect of different steroids on clinical outcomes in infants with MAS. : We systematically searched of PubMed/Medline, Scopus, Embase, Clinical Trials.gov, and Cochrane Library databases from inception to 24 January 2021 without language restriction. Only randomized controlled trials (RCTs) evaluating the effects of steroids in neonates with MAS were included. We calculated relative risks and weighted mean differences (MDs) with 95% confidence intervals (CIs) using a random-effects model to determine the associations between MAS and steroids and GRADE approach was employed for quality of evidence. The main outcomes measures were duration of respiratory distress, oxygen requirement, hospitalization, need for mechanical ventilation, death, and adverse drug reactions. : Seven RCTs involving 397 patients were analyzed. Nebulized budesonide and intravenous (IV) methylprednisolone shortened the duration of respiratory distress (MD, -2.46 days; 95% CI, -3.09 to -1.83 and MD, -3.30 days; 95% CI, -4.07 to -2.52, respectively) (moderate certainty). There was a reduction in duration of oxygen requirement in nebulized budesonide use (MD, -2.40 days; 95% CI, -3.40 to -1.40) (low certainty) and IV methylprednisolone use (MD, -3.30 days; 95% CI, -4.07 to -2.52) (moderate certainty). Nebulized budesonide shortened hospitalization stay (MD, -4.47 days; 95% CI, -8.64 to -0.30 days) (low certainty) as IV methylprednisolone use (MD, -7.23 days; 95% CI, -8.19 to -6.07 days) (moderate certainty). None of steroids benefits in death (low certainty). : Certain types of steroids may benefit the respiratory aspect, but there was no decrease in mortality in MAS infants.
胎粪吸入综合征（MAS）是一种由胎粪污染的羊水吸入肺部引起的疾病，可导致肺部炎症、新生儿发病率和死亡率升高。重要的是，这些 MAS 婴儿需要接受适当的护理，以避免进一步的并发症。类固醇具有抗炎作用，在 MAS 的治疗中可能有效。本研究的目的是评估不同类固醇对 MAS 婴儿临床结局的影响。
我们系统地检索了 PubMed/Medline、Scopus、Embase、ClinicalTrials.gov 和 Cochrane 图书馆数据库，检索时间从建库至 2021 年 1 月 24 日，无语言限制。仅纳入评估类固醇对 MAS 新生儿影响的随机对照试验（RCT）。我们使用随机效应模型计算相对风险和加权均数差（MD）及其 95%置信区间（CI），以确定 MAS 和类固醇之间的关联，并采用 GRADE 方法评估证据质量。主要结局指标为呼吸窘迫持续时间、氧需求、住院时间、机械通气需求、死亡和药物不良反应。
共纳入 7 项 RCT 研究，涉及 397 例患者。雾化布地奈德和静脉注射甲基泼尼松龙可缩短呼吸窘迫持续时间（MD，-2.46 天；95%CI，-3.09 至-1.83 和 MD，-3.30 天；95%CI，-4.07 至-2.52）（中等确定性）。雾化布地奈德可缩短氧需求持续时间（MD，-2.40 天；95%CI，-3.40 至-1.40）（低确定性）和静脉注射甲基泼尼松龙（MD，-3.30 天；95%CI，-4.07 至-2.52）（中等确定性）。雾化布地奈德可缩短住院时间（MD，-4.47 天；95%CI，-8.64 至-0.30 天）（低确定性）和静脉注射甲基泼尼松龙（MD，-7.23 天；95%CI，-8.19 至-6.07 天）（中等确定性）。两种类固醇均不能降低死亡率（低确定性）。
某些类型的类固醇可能对呼吸系统有益，但 MAS 婴儿的死亡率并未降低。
