Department of Neonatal Intensive Care Unit, the First Affiliated Hospital of Gannan Medical University, Ganzhou City 341000, China.
Department of Internal Medicine, the Third Affiliated Hospital of Gannan Medical University, Ganzhou City 341000, China.
Respir Med Res. 2024 Jun;85:101096. doi: 10.1016/j.resmer.2024.101096. Epub 2024 Feb 29.
This systematic review and meta-analysis aimed to evaluate the efficacy and safety of inhaled corticosteroids (budesonide, beclomethasone, or fluticasone propionate) in preventing bronchopulmonary dysplasia (BPD) for premature infants.
Electronic databases, including PubMed, EMBASE, Web of science, Scopus, and Cochrane library, were searched from databases inception to January 2022 for eligible randomized controlled trials. Clinical outcomes such as BPD, mortality, BPD or death, adverse events, and neurodevelopmental outcomes were assessed.
Overall, budesonide was significantly associated with a reduction in BPD at 36 weeks' postmenstrual age (RR 0.48; 95 % CI [0.38, 0.62]) and patent ductus arteriosus (PDA) (RR 0.75; 95 % CI [0.63, 0.89]) compared with control treatments. Early longer duration inhalation of budesonide alone was associated with a lower risk of BPD at 36 weeks' postmenstrual age and PDA compared with controls. Early shorter duration intratracheal instillation of budesonide with surfactant as vehicle was associated with a lower risk of BPD at 36 weeks' postmenstrual age and all-cause mortality compared with surfactant. There was no statistically significant difference between budesonide and control groups regarding neurodevelopmental impairment. Beclomethasone and fluticasone propionate did not show any superior or inferior effect on clinical outcomes compared to control treatments.
These findings suggest that budesonide, especially intratracheal instillation of budesonide using surfactant as a vehicle, is a safe and effective option in preventing BPD for preterm infants. More well-design large-scale trials with long-term follow-ups are necessary to verify the present findings.
本系统评价和荟萃分析旨在评估吸入性皮质类固醇（布地奈德、倍氯米松或丙酸氟替卡松）预防早产儿支气管肺发育不良（BPD）的疗效和安全性。
从数据库建立到 2022 年 1 月，我们在电子数据库（包括 PubMed、EMBASE、Web of Science、Scopus 和 Cochrane 图书馆）中搜索了符合条件的随机对照试验。评估了临床结局，如 BPD、死亡率、BPD 或死亡、不良事件和神经发育结局。
总体而言，与对照组相比，布地奈德治疗组在 36 周校正胎龄时 BPD（RR 0.48；95%CI [0.38, 0.62]）和动脉导管未闭（PDA）（RR 0.75；95%CI [0.63, 0.89]）的发生率显著降低。与对照组相比，早期单独较长时间吸入布地奈德与较低的 36 周校正胎龄和 PDA 发生率相关。与单独使用表面活性剂作为载体的布地奈德相比，早期较短时间气管内滴注布地奈德联合表面活性剂与较低的 36 周校正胎龄和全因死亡率相关。与对照组相比，布地奈德组与神经发育障碍发生率之间无统计学差异。倍氯米松和丙酸氟替卡松在临床结局方面与对照组相比，没有显示出任何优势或劣势。
这些发现表明，布地奈德，尤其是使用表面活性剂作为载体的气管内滴注布地奈德，是预防早产儿 BPD 的一种安全有效的选择。需要更多设计良好的大型试验进行长期随访，以验证目前的发现。
