Steroid use for established bronchopulmonary dysplasia: study protocol for a systematic review and meta-analysis

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.