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Postnatal hydrocortisone for preventing or treating bronchopulmonary dysplasia in preterm infants: a systematic
Lex W Doyle1, Richard A Ehrenkranz, Henry L Halliday
1Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, and Murdoch Children's Research Institute, Parkville, Vic., Australia. lwd@unimelb.edu.au
Insights
Postnatal hydrocortisone did not effectively prevent or treat bronchopulmonary dysplasia (BPD) in preterm infants. The study found few benefits and a risk of gastrointestinal perforation, thus it is not recommended for BPD prevention.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Pharmacology
Background:
- Corticosteroids are frequently used for respiratory failure in preterm infants.
- Hydrocortisone is considered a potentially favorable corticosteroid option.
Purpose of the Study:
- To evaluate the efficacy of postnatal hydrocortisone in preventing or treating bronchopulmonary dysplasia (BPD) in preterm infants.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
- Data on mortality, BPD, combined BPD/mortality, and complications were analyzed.
Main Results:
- Eight RCTs with 880 infants were included; treatment initiated within the first week of life.
- Little evidence supported hydrocortisone's direct effect on BPD or mortality rates.
- An increased risk of gastrointestinal perforation was observed with hydrocortisone use.
Conclusions:
- Current evidence suggests postnatal hydrocortisone, as used in trials, offers minimal benefits and carries risks for BPD prevention.
- There is a lack of RCT data supporting hydrocortisone use in chronically ventilator-dependent infants with established BPD.
Background:
Corticosteroids have been used widely after birth in preterm infants with respiratory failure; hydrocortisone may be preferable to other corticosteroids for this purpose.
Objectives:
To determine if postnatal hydrocortisone is useful to prevent or treat bronchopulmonary dysplasia (BPD) in preterm infants.
Methods:
Randomised controlled trials (RCTs) of postnatal hydrocortisone therapy to prevent or treat BPD were sought. Data regarding clinical outcomes including mortality, BPD, death or BPD, complications during the primary hospitalisation, and long-term outcome were abstracted and analysed using RevMan 5.
Results:
Eight RCTs enrolling a total of 880 participants were eligible. In all trials treatment was started in the first week of life; there were no trials of treatment started in infants who were chronically ventilator-dependent after the first week of life with established or evolving BPD. A meta-analysis of the available trials demonstrated little evidence for a direct effect of hydrocortisone on the rates of BPD, mortality, or the combined outcome of BPD or mortality. Hydrocortisone in the doses used in these eight studies had few beneficial or harmful effects; the notable exception was an increase in gastrointestinal perforation.
Conclusions:
Postnatal hydrocortisone in the doses and regimens used in the reported trials has few beneficial or harmful effects and cannot be recommended for prevention of BPD. There are no randomised trials to substantiate the use of hydrocortisone in chronically ventilator-dependent infants with established or evolving BPD.
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