Abstract:Objective To study the clinical effect and safety of early postnatal application of glucocorticoids in the prevention of bronchopulmonary dysplasia (BPD) in preterm infants. Methods The databases including PubMed, Cochrane Library, Embase, CNKI, Wanfang Data, and VIP were comprehensively searched for articles on early postnatal application of glucocorticoids in the prevention of BPD in preterm infants published up to June 2016. Review Manager 5.3 was used for the Meta analysis of 16 randomized controlled trials (RCTs) that met the inclusion criteria. Results A total of 2 962 participants were enrolled in the 16 RCTs, with 1 486 patients in the trial group and 1 476 in the control group. The Meta analysis showed that early postnatal application of glucocorticoids reduced the incidence rate of BPD at a corrected gestational age of 36 weeks (OR=0.73, 95%CI:0.61-0.87, P=0.0004), but there was an increase in the risk of hyperglycemia (OR=1.61, 95%CI:1.24-2.09, P=0.0003), hypertension (OR=1.63, 95%CI:1.11-2.38, P=0.01), and intestinal perforation (OR=1.51, 95%CI:1.12-2.04, P=0.007). Conclusions At present, it is not recommended to use glucocorticoids to prevent BPD in preterm infants. Its advantages and disadvantages need further studies, with special focuses on the adverse effects of hyperglycemia, hypertension, and intestinal perforation.
JI Feng-Juan,YIN Yong,XU Juan et al. Early postnatal application of glucocorticoids for preventing bronchopulmonary dysplasia in preterm infants: a Meta analysis[J]. CJCP, 2017, 19(6): 638-645.
Choi CW, Kim BI, Kim HS, et al. Increase of interleukin-6 in tracheal aspirate at birth:a predictor of subsequent bronchopulmonary dysplasia in preterm infants[J]. Acta Paediatr, 2006, 95(1):38-43.
[4]
Patterson AM, Taciak V, Lovchik J, et al. Ureaplasma urealyticum respiratory tract colonization is associated with an increase in interleukin 1-beta and tumor necrosis factor alpha relative to interleukin 6 in tracheal aspirates of preterm infants[J]. Pediatr Infect Dis J, 1998, 17(4):321-328.
[5]
Halliday HL, Ehrenkranz RA, Doyle LW. Early (< 8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants[J]. Cochrane Database Syst Rev, 2010, (1):CD001146.
[6]
Shah VS, Ohlsson A, Halliday HL, et al. Early administration of inhaled corticosteroids for preventing chronic lung disease in ventilated very low birth weight preterm neonates[J]. Cochrane Database Syst Rev, 2012, (5):Cd001969.
[7]
Vermont Oxford Network Steroid Study Group. Early postnatal dexamethasone therapy for the prevention of chronic lung disease[J]. Pediatrics, 2001, 108(3):741-748.
[8]
Anttila E, Peltoniemi O, Haumont D, et al. Early neonatal dexamethasone treatment for prevention of bronchopulmonary dysplasia. Randomised trial and meta-analysis evaluating the duration of dexamethasone therapy[J]. Eur J Pediatr, 2005, 164(8):472-481.
[9]
Bassler D, Plavka R, Shinwell ES, et al. Early inhaled budesonide for the prevention of bronchopulmonary dysplasia[J]. N Engl J Med, 2015, 373(16):1497-1506.
[10]
Biswas S, Buffery J, Enoch H, et al. Pulmonary effects of triiodothyronine (T3) and hydrocortisone (HC) supplementation in preterm infants less than 30 weeks gestation:results of the THORN trial-thyroid hormone replacement in neonates[J]. Pediatr Res, 2003, 53(1):48-56.
[11]
Bonsante F, Latorre G, Iacobelli S, et al. Early low-dose hydrocortisone in very preterm infants:a randomized, placebo-controlled trial[J]. Neonatology, 2007, 91(4):217-221.
[12]
Cole CH, Colton T, Shah BL, et al. Early inhaled glucocorticoid therapy to prevent bronchopulmonary dysplasia[J]. N Engl J Med, 1999, 340(13):1005-1010.
[13]
Efird MM, Heerens AT, Gordon PV, et al. A randomized-controlled trial of prophylactic hydrocortisone supplementation for the prevention of hypotension in extremely low birth weight infants[J]. J Perinatol, 2005, 25(2):119-124.
[14]
Fok TF, Lam K, Dolovich M, et al. Randomised controlled study of early use of inhaled corticosteroid in preterm infants with respiratory distress syndrome[J]. Arch Dis Child Fetal Neonatal Ed, 1999, 80(3):F203-F208.
[15]
Jangaard KA, Stinson DA, Allen AC, et al. Early prophylactic inhaled beclomethasone in infants less than 1250 g for the prevention of chronic lung disease[J]. Paediatr Child Health, 2002, 7(1):13-19.
[16]
Jonsson B, Eriksson M, Soder O, et al. Budesonide delivered by dosimetric jet nebulization to preterm very low birthweight infants at high risk for development of chronic lung disease[J]. Acta Paediatr, 2000, 89(12):1449-1455.
[17]
Merz U, Kusenbach G, Hausler M, et al. Inhaled budesonide in ventilator-dependent preterm infants:a randomized, double-blind pilot study[J]. Biol Neonate, 1999, 75(1):46-53.
[18]
Ng PC, Lee CH, Bnur FL, et al. A double-blind, randomized, controlled study of a "stress dose" of hydrocortisone for rescue treatment of refractory hypotension in preterm infants[J]. Pediatrics, 2006, 117(2):367-375.
[19]
Peltoniemi O, Kari MA, Heinonen K, et al. Pretreatment cortisol values may predict responses to hydrocortisone administration for the prevention of bronchopulmonary dysplasia in high-risk infants[J]. J Pediatr, 2005, 146(5):632-637.
[20]
Stark AR, Carlo WA, Tyson JE, et al. Adverse effects of early dexamethasone in extremely-low-birth-weight infants. National Institute of Child Health and Human Development Neonatal Research Network[J]. N Engl J Med, 2001, 344(2):95-101.
[21]
Vento G, Matassa PG, Zecca E, et al. Effect of dexamethasone on tracheobronchial aspirate fluid cytology and pulmonary mechanics in preterm infants[J]. Pharmacology, 2004, 71(3):113-119.
[22]
Watterberg KL, Gerdes JS, Cole CH, et al. Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia:a multicenter trial[J]. Pediatrics, 2004, 114(6):1649-1657.
Watterberg KL, Gerdes JS, Gifford KL, et al. Prophylaxis against early adrenal insufficiency to prevent chronic lung disease in premature infants[J]. Pediatrics, 1999, 104(6):1258-1263.
[25]
Van Goudoever JB, Wattimena JD, Carnielli VP, et al. Effect of dexamethasone on protein metabolism in infants with bronchopulmonary dysplasia[J]. J Pediatr, 1994, 124(1):112-118.
[26]
Gibson AT, Pearse RG, Wales JK. Growth retardation after dexamethasone administration:assessment by knemometry[J]. Arch Dis Child, 1993, 69(5 Spec No):505-509.
[27]
Werner JC, Sicard RE, Hansen TW, et al. Hypertrophic cardiomyopathy associated with dexamethasone therapy for bronchopulmonary dysplasia[J]. J Pediatr, 1992, 120(2 Pt 1):286-291.