Efficacy and safety of different inhaled corticosteroids for bronchopulmonary dysplasia prevention in preterm infants: A systematic review and meta-analysis
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,...
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description | 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. |
doi_str_mv | 10.1016/j.resmer.2024.101096 |
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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.</description><identifier>ISSN: 2590-0412</identifier><identifier>EISSN: 2590-0412</identifier><identifier>DOI: 10.1016/j.resmer.2024.101096</identifier><identifier>PMID: 38744231</identifier><language>eng</language><publisher>France: Elsevier Masson SAS</publisher><subject><![CDATA[Administration, Inhalation ; Adrenal Cortex Hormones - administration & dosage ; Adrenal Cortex Hormones - adverse effects ; Adrenal Cortex Hormones - therapeutic use ; Beclomethasone ; Beclomethasone - administration & dosage ; Bronchopulmonary dysplasia ; Bronchopulmonary Dysplasia - epidemiology ; Bronchopulmonary Dysplasia - prevention & control ; Budesonide ; Budesonide - administration & dosage ; Budesonide - therapeutic use ; Ductus Arteriosus, Patent - drug therapy ; Ductus Arteriosus, Patent - prevention & control ; Female ; Fluticasone ; Fluticasone - administration & dosage ; Fluticasone - therapeutic use ; Humans ; Infant, Newborn ; Infant, Premature ; Male ; Premature infant ; Pulmonary Surfactants - administration & dosage ; Randomized Controlled Trials as Topic ; Treatment Outcome]]></subject><ispartof>Respiratory medicine and research, 2024-06, Vol.85, p.101096, Article 101096</ispartof><rights>2024 SPLF and Elsevier Masson SAS</rights><rights>Copyright © 2024 SPLF and Elsevier Masson SAS. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c311t-a9a09e01af1ed787bf7ba056308f0c0475c38e2a077ae2ca8aa205755ef0e5883</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38744231$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhang, Minghai</creatorcontrib><creatorcontrib>Zhang, Wei</creatorcontrib><creatorcontrib>Liao, Hongqun</creatorcontrib><title>Efficacy and safety of different inhaled corticosteroids for bronchopulmonary dysplasia prevention in preterm infants: A systematic review and meta-analysis</title><title>Respiratory medicine and research</title><addtitle>Respir Med Res</addtitle><description>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.</description><subject>Administration, Inhalation</subject><subject>Adrenal Cortex Hormones - administration & dosage</subject><subject>Adrenal Cortex Hormones - adverse effects</subject><subject>Adrenal Cortex Hormones - therapeutic use</subject><subject>Beclomethasone</subject><subject>Beclomethasone - administration & dosage</subject><subject>Bronchopulmonary dysplasia</subject><subject>Bronchopulmonary Dysplasia - epidemiology</subject><subject>Bronchopulmonary Dysplasia - prevention & control</subject><subject>Budesonide</subject><subject>Budesonide - administration & dosage</subject><subject>Budesonide - therapeutic use</subject><subject>Ductus Arteriosus, Patent - drug therapy</subject><subject>Ductus Arteriosus, Patent - prevention & control</subject><subject>Female</subject><subject>Fluticasone</subject><subject>Fluticasone - administration & dosage</subject><subject>Fluticasone - therapeutic use</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Infant, Premature</subject><subject>Male</subject><subject>Premature infant</subject><subject>Pulmonary Surfactants - administration & dosage</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Treatment Outcome</subject><issn>2590-0412</issn><issn>2590-0412</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9u1DAQxiMEolXbN6iQj1yyjJN4k-WAVFXlj1SJSzlbs_ZY9Sqxg8cLyrvwsHibgjhx8tj6fd_M-KuqawkbCXL77rBJxBOlTQNNd3qC3fZFdd6oHdTQyeblP_VZdcV8AIBG9hKG7nV11g591zWtPK9-3TnnDZpFYLCC0VFeRHTCeucoUcjCh0ccyQoTU_YmcqYUvWXhYhL7FIN5jPNxnGLAtAi78DwiexRzoh9F7mMoDqdb0U2ldBgyvxc3gpdiNWHxFAX19PNpgoky1hhwXNjzZfXK4ch09XxeVN8-3j3cfq7vv376cntzX5tWylzjDmFHINFJsv3Q712_R1DbFgYHBrpemXagBqHvkRqDA2IDqleKHJAahvaierv6zil-PxJnPXk2NI4YKB5Zt6BUp-QAUNBuRU2KzImcnpOfyupagj5Fow96jUafotFrNEX25rnDcT-R_Sv6E0QBPqwAlT3LbyTNxlMwZH0ik7WN_v8dfgPfPqWI</recordid><startdate>202406</startdate><enddate>202406</enddate><creator>Zhang, Minghai</creator><creator>Zhang, Wei</creator><creator>Liao, Hongqun</creator><general>Elsevier Masson SAS</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202406</creationdate><title>Efficacy and safety of different inhaled corticosteroids for bronchopulmonary dysplasia prevention in preterm infants: A systematic review and meta-analysis</title><author>Zhang, Minghai ; Zhang, Wei ; Liao, Hongqun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c311t-a9a09e01af1ed787bf7ba056308f0c0475c38e2a077ae2ca8aa205755ef0e5883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Administration, Inhalation</topic><topic>Adrenal Cortex Hormones - administration & dosage</topic><topic>Adrenal Cortex Hormones - adverse effects</topic><topic>Adrenal Cortex Hormones - therapeutic use</topic><topic>Beclomethasone</topic><topic>Beclomethasone - administration & dosage</topic><topic>Bronchopulmonary dysplasia</topic><topic>Bronchopulmonary Dysplasia - epidemiology</topic><topic>Bronchopulmonary Dysplasia - prevention & control</topic><topic>Budesonide</topic><topic>Budesonide - administration & dosage</topic><topic>Budesonide - therapeutic use</topic><topic>Ductus Arteriosus, Patent - drug therapy</topic><topic>Ductus Arteriosus, Patent - prevention & control</topic><topic>Female</topic><topic>Fluticasone</topic><topic>Fluticasone - administration & dosage</topic><topic>Fluticasone - therapeutic use</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Infant, Premature</topic><topic>Male</topic><topic>Premature infant</topic><topic>Pulmonary Surfactants - administration & dosage</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhang, Minghai</creatorcontrib><creatorcontrib>Zhang, Wei</creatorcontrib><creatorcontrib>Liao, Hongqun</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Respiratory medicine and research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhang, Minghai</au><au>Zhang, Wei</au><au>Liao, Hongqun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy and safety of different inhaled corticosteroids for bronchopulmonary dysplasia prevention in preterm infants: A systematic review and meta-analysis</atitle><jtitle>Respiratory medicine and research</jtitle><addtitle>Respir Med Res</addtitle><date>2024-06</date><risdate>2024</risdate><volume>85</volume><spage>101096</spage><pages>101096-</pages><artnum>101096</artnum><issn>2590-0412</issn><eissn>2590-0412</eissn><abstract>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.</abstract><cop>France</cop><pub>Elsevier Masson SAS</pub><pmid>38744231</pmid><doi>10.1016/j.resmer.2024.101096</doi></addata></record> |
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subjects | Administration, Inhalation Adrenal Cortex Hormones - administration & dosage Adrenal Cortex Hormones - adverse effects Adrenal Cortex Hormones - therapeutic use Beclomethasone Beclomethasone - administration & dosage Bronchopulmonary dysplasia Bronchopulmonary Dysplasia - epidemiology Bronchopulmonary Dysplasia - prevention & control Budesonide Budesonide - administration & dosage Budesonide - therapeutic use Ductus Arteriosus, Patent - drug therapy Ductus Arteriosus, Patent - prevention & control Female Fluticasone Fluticasone - administration & dosage Fluticasone - therapeutic use Humans Infant, Newborn Infant, Premature Male Premature infant Pulmonary Surfactants - administration & dosage Randomized Controlled Trials as Topic Treatment Outcome |
title | Efficacy and safety of different inhaled corticosteroids for bronchopulmonary dysplasia prevention in preterm infants: A systematic review and meta-analysis |
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