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Steroid use for established bronchopulmonary dysplasia: study protocol for a systematic review and meta-analysis
Sabina Strashun1, Joanna Seliga-Siwecka2, Roberto Chioma3
1University of Limerick Graduate Entry Medical School, Limerick, Ireland.
Insights
This systematic review protocol examines the effectiveness and safety of postnatal steroids for treating established bronchopulmonary dysplasia (BPD) in preterm infants. It aims to provide evidence on steroid use for this chronic respiratory condition.
Area of Science:
- Neonatal medicine
- Pediatric pulmonology
- Evidence-based medicine
Background:
- Postnatal steroids can prevent bronchopulmonary dysplasia (BPD) in preterm infants but carry neurological risks.
- Established BPD treatment with steroids aims to reduce mortality, hospital stay, and home oxygen use, alleviating parental stress and healthcare costs.
- Late-stage steroid administration may offer a better neurodevelopmental safety profile due to infant brain maturation.
Purpose of the Study:
- To systematically review the efficacy of postnatal steroids in treating established BPD in preterm infants.
- To assess the long-term safety and neurodevelopmental outcomes associated with postnatal steroid treatment for BPD.
- To synthesize evidence from diverse study designs to inform clinical practice.
Main Methods:
- Comprehensive literature search of MEDLINE, Embase, Cochrane databases, and grey literature without time or language restrictions.
- Inclusion of case-control studies, cohort studies, and randomized or non-randomized trials of infants with moderate to severe BPD at 36 weeks' postmenstrual age.
- Separate analysis of observational studies and clinical trials, using random-effects models for meta-analysis and subgroup analyses for covariates.
Main Results:
- Data extraction forms developed a priori for consistent data collection.
- Meta-analysis will combine data using Odds Ratios (OR) with 95% Confidence Intervals (CI) for dichotomous outcomes and mean differences for continuous outcomes.
- Subgroup analyses will explore factors influencing treatment efficacy and safety.
Conclusions:
- This systematic review protocol outlines a rigorous approach to evaluate postnatal steroid therapy for established BPD.
- Findings will clarify the balance between therapeutic benefits and potential neurological risks.
- The study aims to provide crucial evidence for optimizing BPD management in preterm infants.
Introduction:
Postnatal steroids during the first few weeks of life have been demonstrated to be effective in decreasing the incidence of bronchopulmonary dysplasia (BPD), a serious chronic respiratory condition affecting preterm infants. However, this preventive option is limited by the concern of neurological side effects. Steroids are used to treat established BPD in an attempt to reduce mortality, and length of stay and home oxygen therapy, both of which associated with high levels of parental stress and healthcare costs. Moreover, a late timing for steroid treatment may show a more favourable safety profile in terms of neurodevelopment outcomes, considering the added postnatal brain maturation of these infants. Here, we report a protocol for a systematic review, which aims to determine the efficacy and long-term safety of postnatal steroids for the treatment of established BPD in preterm infants.
Methods And Analysis:
MEDLINE, Embase, Cochrane databases and sources of grey literature for conference abstracts and trial registrations will be searched with no time or language restriction. We will include case-control studies, cohort studies and non-randomised or randomised trials that evaluate postnatal steroids for infants diagnosed with moderate or severe established BPD at 36 weeks' postmenstrual age. We will pool data from studies that are sufficiently similar to make this appropriate. Data extraction forms will be developed a priori. Observational studies and non-randomised and randomised clinical trials will be analysed separately. We will combine OR with 95% CI for dichotomous outcomes and the mean difference (95% CI) for continuous outcomes. We will account for the expected heterogeneity by using a random-effects model. We will perform subgroup analysis based on the a priori determined covariate of interest.
Ethics And Dissemination:
Systematic reviews are exempted from approval by an ethics committee. Attempts will be sought to publish all results.
Prospero Registration Number:
CRD42021218881.
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