Steroid Use for Established Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis

Area of Science:

• Neonatology
• Pediatric Pulmonology
• Pharmacology

Background:

• Bronchopulmonary dysplasia (BPD) is a chronic lung disease in preterm infants.
• Evidence regarding steroid treatment for established BPD is limited.
• A systematic review and meta-analysis on this topic has not been previously conducted.

Purpose of the Study:

• To synthesize the available evidence on the efficacy and safety of postnatal steroid use for established BPD.
• To evaluate the impact of steroids on oxygen requirements, length of hospital stay, and mortality in infants with BPD.

Main Methods:

• Systematic search of MEDLINE, Embase, Cochrane databases, and gray literature until October 2024.
• Inclusion of randomized and non-randomized trials of postnatal steroids initiated from 28 days of life in preterm infants diagnosed with BPD.
• Evidence certainty assessed using the GRADE approach.

Main Results:

• Steroids significantly reduced oxygen requirement (1.6% daily mean difference) with moderate quality evidence.
• No significant differences were found in total oxygen duration, length of stay, or mortality.
• Steroid use was associated with transient increases in blood pressure, reduced weight gain during treatment, but equal overall growth.

Conclusions:

• Current moderate-quality evidence does not support steroid treatment as standard care for established BPD.
• Corticosteroids are frequently used, highlighting a gap between evidence and practice.
• Large-scale randomized controlled trials are urgently needed to establish optimal treatment strategies for BPD.