Intratracheal Administration of Budesonide-Surfactant in Prevention of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants: A Systematic Review and Meta-Analysis

Autor: Rohini Venkataraman, Abhay Lodha, Helen Lee Robertson, Majeeda Kamaluddeen, Shabih U. Hasan
Rok vydání: 2017
Předmět:
Pulmonary and Respiratory Medicine
Budesonide
Pediatrics
medicine.medical_specialty
medicine.medical_treatment
behavioral disciplines and activities
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
030225 pediatrics
Administration
Inhalation
mental disorders
medicine
Humans
Infant
Very Low Birth Weight
030212 general & internal medicine
Glucocorticoids
Bronchopulmonary Dysplasia
Randomized Controlled Trials as Topic
Mechanical ventilation
Respiratory Distress Syndrome
Newborn
business.industry
Incidence (epidemiology)
Infant
Newborn
Pulmonary Surfactants
medicine.disease
Respiration
Artificial
Clinical trial
Low birth weight
Bronchopulmonary dysplasia
Meta-analysis
Pediatrics
Perinatology and Child Health
medicine.symptom
business
medicine.drug
Zdroj: Pediatric Pulmonology. 52:968-975
ISSN: 8755-6863
DOI: 10.1002/ppul.23680
Popis: Despite the near universal adaptation of gentle mechanical ventilation, surfactant use and non-invasive respiratory support, bronchopulmonary dysplasia (BPD) remains one of the most common respiratory morbidities in very low birth weight (VLBW) infants. Thus, the objective of this review was to evaluate the efficacy of intra-tracheal administration of budesonide-surfactant mixture in preventing bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants. MEDLINE, EMBASE, and PubMed were searched for randomized clinical trials in which intra-tracheal administration of budesonide-surfactant was used to prevent BPD in infants. The primary outcomes were BPD and composite outcome of death or BPD. Meta-analysis of the two clinical trials revealed that infants who received intra-tracheal instillation of budesonide-surfactant mixture demonstrated 43% reduction in the risk of BPD (RR: 0.57; 95%CI: 0.43-0.76, NNT = 5). Although mortality was not different between the groups (OR: 0.61; 95%CI: 0.34-1.04), a 40% reduction was observed in the composite outcome of death or BPD in the budesonide-surfactant group (RR: 0.60; 95%CI: 0.49-0.74, NNT = 3). Thus, this review concludes that intra-tracheal administration of budesonide-surfactant combination was associated with decreased incidence of BPD alone or composite outcome of death or BPD in VLBW infants though there is a need for larger trials before it can be recommended as a standard of care.
Databáze: OpenAIRE
Externí odkaz: