Raghuveer Talkad S, Zackula Rosey E, Lakhotia Richa, Binder Stephanie A
Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, KS, USA.
Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS, USA.
J Perinatol. 2024 Sep 2. doi: 10.1038/s41372-024-02097-w.
It is unclear if systemic steroids decrease the risk of Bronchopulmonary Dysplasia (BPD) while increasing the risk of neurodevelopmental impairment (NDI).
Conduct a systematic review of randomized controlled trials of systemic steroids to evaluate the risk of BPD, mortality, and NDI in premature infants ≤30 weeks.
MEDLINE, EBSCOhost, Web of Science, Cochrane Library, Embase, and CINAHL.
Randomized clinical trials of Dexamethasone (DEX) or Hydrocortisone (HC) to prevent BPD in premature infants ≤ 30 weeks.
Data were extracted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Random-effects meta-analyses and multivariable meta-regression were conducted.
Primary outcomes were BPD, mortality, and NDI. Secondary outcomes were hypertension, hyperglycemia, sepsis, intestinal perforation, necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP). The a priori hypothesis was that steroids would reduce the risk of BPD without increasing NDI.
There were 6377 preterm infants in the 44 (32 DEX, 13 HC) selected studies. DEX significantly reduced the risk of BPD, RR = 0.66, (95% CI, 0.56-0.78). The most effective DEX regimen was medium cumulative dose (2 to 3 mg/kg), RR = 0.43 (95% CI, 0.29-0.65); day of initiation <8 days: RR = 0.68, (95% CI, 0.59-0.79); and treatment for ≥14 days: RR = 0.67 (95% CI, 0.55-0.80). HC did not significantly decrease the risk of BPD, RR = 0.98, (95% CI, 0.87-1.10). Neither DEX, (RR = 0.92, 95% CI, 0.78-1.09) nor HC (RR = 0.83, 95% CI, 0.68-1.01) decrease the risk of mortality. The risk of CP was not increased by either DEX (RR = 1.09, 95% CI, 0.55-2.17) or HC (RR = 1.18, 95% CI, 0.75-1.87). There were no significant differences between steroids and placebo for MDI/PDI scores. Multivariable meta-regression models showed that DEX significantly reduced the risk of BPD without increased risk of CP. DEX increased the risk of hypertension and hyperglycemia. Studies showed high heterogeneity, differing treatment regimen, missing data and different rates of follow-up.
DEX, but not HC, significantly decreased the risk of BPD. Neither steroid showed an increased risk of NDI or mortality.
尚不清楚全身用类固醇在增加神经发育障碍（NDI）风险的同时是否会降低支气管肺发育不良（BPD）的风险。
对全身用类固醇的随机对照试验进行系统评价，以评估胎龄≤30周的早产儿发生BPD、死亡和NDI的风险。
MEDLINE、EBSCOhost、科学引文索引、考克兰图书馆、Embase和护理学与健康领域数据库。
地塞米松（DEX）或氢化可的松（HC）预防胎龄≤30周早产儿BPD的随机临床试验。
采用系统评价和Meta分析的首选报告项目指南提取数据。进行随机效应Meta分析和多变量Meta回归。
主要结局为BPD、死亡和NDI。次要结局为高血压、高血糖、败血症、肠穿孔、坏死性小肠结肠炎（NEC）和早产儿视网膜病变（ROP）。预先设定的假设是类固醇会降低BPD风险而不增加NDI。
在所选的44项研究（32项DEX研究，13项HC研究）中有6377例早产儿。DEX显著降低了BPD风险，RR = 0.66，（95%CI，0.56 - 0.78）。最有效的DEX方案是中等累积剂量（2至3mg/kg），RR = 0.43（95%CI，0.29 - 0.65）；开始治疗日<8天：RR = 0.68，（95%CI，0.59 - 0.79）；治疗≥14天：RR = 0.67（95%CI，0.55 - 0.80）。HC未显著降低BPD风险，RR = 0.98，（95%CI，0.87 - 1.10）。DEX（RR = 0.92，95%CI，0.78 - 1.09）和HC（RR = 0.83，95%CI，0.68 - 1.01）均未降低死亡风险。DEX（RR = 1.09，95%CI，0.55 - 2.17）或HC（RR = 1.18，95%CI，0.75 - 1.87）均未增加脑瘫风险。类固醇与安慰剂在MDI/PDI评分方面无显著差异。多变量Meta回归模型显示，DEX显著降低BPD风险且未增加脑瘫风险。DEX增加了高血压和高血糖风险。研究显示存在高度异质性，治疗方案不同、数据缺失以及随访率不同。
DEX而非HC显著降低了BPD风险。两种类固醇均未显示出NDI或死亡风险增加。
