Beta
12786

Postnatal Corticosteroids to Treat or Prevent Bronchopulmonary Dysplasia in Preterm Infants

Article

Last updated: 24 Dec 2024

Subjects

-

Tags

-

Abstract

Background: The lungs of particularly newborn are fragile and can be easily damaged.   With injury, scarring may follow which is translated into difficult breathing and increased oxygen needs, a condition called bronchopulmonary dysplasia (BPD) or Chronic Lung Disease (CLD). Since inflammation plays an important role in the pathogenesis of CLD, corticosteroids, especially dexamethasone, have been extensively used to avert or treat CLD. Thus, several studies suggest that systemic corticosteroids decrease the duration of ventilator dependence. Aim of the Study: investigate the beneficial and harmful effects of the use of steroid in the prevention and treatment of BPD. Methods: A systematic review and meta-analysis of observational studies and randomized controlled trials was conducted. A review of the scientific literature. Pubmed, Embase and Central were searched to identify randomized controlled trials that investigated postnatal corticosteroids treatment for BPD were the primary endpoints. Identification of papers and data extraction were performed by two independent researchers. We searched for relevant trials in the Cochrane Library, MEDLINE (from 1955), Embase (from 1970), the Transfusion Evidence Library (from 1980), and ongoing trial databases; all searches current to September 2017.Results: The search yielded seven RCTs which enrolled a total of 1862 participants eligible for inclusion in the present review. There were significant beneficial outcomes such as lower rates of failure to extubate and decreased risks of chronic lung disease at both 28 days (RR 0.84, 95% CI 0.83 to 0.87) and 36 weeks' postmenstrual age (RR 0.77, 95% CI 0.72 to 0.84), death or chronic lung disease at 28 days (RR 0.9, 95% CI 0.85 to 0.96) and 36 weeks' postmenstrual age (RR 0.91, 95% CI 0.87 to 0.96). Nevertheless, there were no significant differences in the rates of neonatal mortality (RR= 1.06, 95% CI 0.93, 1.26), periventricular leukomalacia (RR 1.16, 95% CI 0.9 to 1.46), necrotizing enterocolitis or pulmonary haemorrhage (RR 1.21, 95% CI 0.83 to 1.62). In contrast, gastrointestinal bleeding (RR 2.13, 95% CI 1.41 to 2.84) and intestinal perforation (RR 1.77, 95% CI 1.46 to 2.1) were imperative adverse effects. Moreover, many adverse neurological effects were found at follow-up examinations, including developmental delay (RR 1.72, 95% CI 1.4 to 2.05) and cerebral palsy (RR 1.56, 95% CI 1.03 to 2.1). Additionally, the rates of the combined outcomes of death or cerebral palsy (1.92, 95% CI 1.18 to 2.67), or of death or major neurosensory disability (RR 1.25, 95% CI 0.98 to 1.53), were not significantly increased. In subgroup analyses by type of corticosteroid, most of the advantageous and disadvantageous effects were related chiefly to dexamethasone whilst hydrocortisone had slight effect on any of the outcomes except for an increase in intestinal perforation and a borderline reduction in patent ductus arteriosus. The overall risk for bias was low as all were RCTs using robust methods. Conclusion: despite the fact that early corticosteroid treatment can have beneficial outcome for BPD management through facilitation of extubation and decreasing the risk of chronic lung disease and patent ductus arteriosus, it ,on the other hand, results in short-term adverse effects including gastrointestinal bleeding, intestinal perforation, hyperglycaemia, hypertension, hypertrophic cardiomyopathy and growth failure.    Clinicians should carefully assess the risks of a short course of glucocorticoid therapy to mitigate BPD for premature neonates such that an individualized decision should be made in conjunction with the infant's parents.  

DOI

10.12816/0042866

Authors

First Name

Alsuhaymi Zuhair

Last Name

Hamdan A

MiddleName

-

Affiliation

Mikhwah General Hospital

Email

-

City

-

Orcid

-

First Name

Zamil Mufleh

Last Name

Al-Wahbi

MiddleName

-

Affiliation

Khamis Mushait Maternity & Children Hospital (KMMCH),

Email

-

City

-

Orcid

-

First Name

Abdulmohsen Abdulkarim

Last Name

Alanazi

MiddleName

-

Affiliation

King Abdullah Bin Abdulaziz University Hospital,

Email

-

City

-

Orcid

-

First Name

Zayed mohammed Z

Last Name

Al Almathlma

MiddleName

-

Affiliation

Mohayil General Hospital

Email

-

City

-

Orcid

-

First Name

Samar Osama Mohamed Mahmoud

Last Name

Kassem

MiddleName

-

Affiliation

Umm Al Qura University

Email

-

City

-

Orcid

-

First Name

Faisal Ali A

Last Name

Alotaibi

MiddleName

-

Affiliation

Taif University

Email

-

City

-

Orcid

-

First Name

Ghadi abdullah

Last Name

Aljehani

MiddleName

-

Affiliation

Ibn Sina College

Email

-

City

-

Orcid

-

First Name

Mushari Aber F

Last Name

Alonazi

MiddleName

-

Affiliation

Aljouf University

Email

-

City

-

Orcid

-

First Name

Abdulrahman Sulaiman I

Last Name

Alshudokhi

MiddleName

-

Affiliation

Alfaisal University

Email

-

City

-

Orcid

-

First Name

Alanoud Thamer

Last Name

Al Drasouny

MiddleName

-

Affiliation

Almaarefa Colleges For Science And Technology

Email

-

City

-

Orcid

-

First Name

Fatimah Fayiz

Last Name

Alghanim

MiddleName

-

Affiliation

Imam Abdulrahman Bin Faisal University

Email

-

City

-

Orcid

-

First Name

Toqa Eissa

Last Name

Aljowaid

MiddleName

-

Affiliation

Ibn Sina College

Email

-

City

-

Orcid

-

Volume

69

Article Issue

8

Related Issue

2381

Issue Date

2017-10-01

Receive Date

2018-09-06

Publish Date

2017-10-01

Page Start

3,144

Page End

3,153

Print ISSN

1687-2002

Online ISSN

2090-7125

Link

https://ejhm.journals.ekb.eg/article_12786.html

Detail API

https://ejhm.journals.ekb.eg/service?article_code=12786

Order

29

Type

Original Article

Type Code

606

Publication Type

Journal

Publication Title

The Egyptian Journal of Hospital Medicine

Publication Link

https://ejhm.journals.ekb.eg/

MainTitle

Postnatal Corticosteroids to Treat or Prevent Bronchopulmonary Dysplasia in Preterm Infants

Details

Type

Article

Created At

22 Jan 2023