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Inhaled steroids for neonatal chronic lung disease
1PICU, Addenbrookes Hospital, Hills Road, Cambridge, UK. paulalister@homesteadbarn.freeserve.co.uk
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Inhaled corticosteroids significantly improve extubation rates in premature infants with bronchopulmonary dysplasia (BPD). This treatment shows no increased risk of sepsis, offering a safer alternative for respiratory support.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Pharmacology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease common in premature infants.
- Systemic steroids offer temporary respiratory improvement but carry significant side effects.
- Inhaled corticosteroids present a potentially safer alternative with fewer adverse effects.
Purpose of the Study:
- To evaluate the efficacy of inhaled corticosteroids in reducing BPD-related morbidity.
- To compare inhaled corticosteroid treatment with placebo in infants with BPD.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) from Cochrane Database, literature, and expert contact.
- Inclusion criteria: infants with BPD treated with inhaled steroids versus placebo; exclusion: systemic steroid use.
- Analysis focused on ventilated and non-ventilated infant subgroups, assessing extubation rates and sepsis risk.
Main Results:
- Inhaled steroids markedly reduced the inability to extubate in ventilated infants (OR 0.12, 95% CI 0.03-0.43).
- Risk of sepsis was comparable between inhaled steroid and placebo groups (OR 0.72, 95% CI 0.21-2.43).
- Insufficient data prevented analysis of drug variations, duration, or efficacy in non-ventilated infants.
Conclusions:
- Inhaled corticosteroids administered for 1-4 weeks improve extubation rates in ventilated BPD infants without increasing sepsis risk.
- Efficacy of inhaled steroids in non-ventilated infants with BPD remains inconclusive due to limited data.
Background:
Bronchopulmonary dysplasia (BPD) is a chronic disorder associated with prematurity. Systemic steroids induce at least a temporary improvement in respiratory function, but are associated with adverse side effects. Inhaled steroids have fewer side effects.
Objectives:
To determine if inhaled corticosteroids are effective in alleviating the morbidity of bronchopulmonary dysplasia (BPD) compared to 0-placebo.
Search Strategy:
We identified randomised, controlled trials (RCT) within the Cochrane Database, references from retrieved trials, hand searches of journals and contact with pharmaceutical companies and experts in this field.
Selection Criteria:
Only randomised controlled trials involving infants with chronic lung disease of prematurity and treated with inhaled steroids versus placebo were included. Patients receiving systemic corticosteroids were excluded. Co-interventions included antenatal systemic steroids, routine neonatal intensive care, ventilatory support, surfactant replacement therapy, diuretics and bronchodilators.
Data Collection And Analysis:
Four of the seven included trials were of good methodological quality. There were five parallel-group trials in ventilated infants. These were comparable in terms of population, co-interventions and need for increased inspired oxygen concentration. They differed in terms of type, dose and duration (7-28 days) of inhaled steroids. Two cross-over trials were performed in non-ventilated patients.
Main Results:
The inability to extubate during treatment was markedly reduced in infants treated with inhaled steroids; Peto Odds Ratio (OR) 0.12, 95% Confidence Interval (CI) 0.03 to 0.43. There was heterogeneity in this finding, however, with one study that contributed 30% of the total number of patients reporting no successful extubations in either treatment arm over one week. The risk of sepsis appeared similar between the two groups (N=3, OR=0.72, 95%CI: 0.21 to 2.43). The small number of trials precluded analysis to examine the effect of differences in drug, duration of therapy, delivery system, co-interventions, and disease severity. Reduced oxygen requirements were reported in one of the two trials performed in non-ventilated infants, but inadequate data reporting precluded pooling of data.
Reviewer'S Conclusions:
In ventilated infants with BPD, inhaled steroids administered for 1 to 4 weeks improved the rate of extubation with no apparent increase in the risk of sepsis. No firm conclusion could be derived with regard to the efficacy of inhaled steroids in non-ventilated infants.