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

Introduction: Evidence on steroid treatment for established bronchopulmonary dysplasia (BPD) is sparse. To our knowledge, a systematic review has never been conducted on this topic. This meta-analysis aims to synthesize available evidence for the use of postnatal steroids to treat established BPD. Methods: MEDLINE, Embase, Cochrane databases, and gray literature sources were searched without time or language restrictions until October 2024. We included randomized and non-randomized trials (analyzed separately) that evaluated postnatal steroids started from 28 days of life in preterm infants diagnosed with BPD. Certainty of evidence was assessed using the GRADE approach. Results: The search retrieved 9113 records, and 20 studies were included. Meta-analysis of the RCTs demonstrated that steroids significantly reduced oxygen requirement (daily mean difference of 1.6%, 95% CI 0.25-2.95), but the analysis did not identify significant differences in total duration of supplemental oxygen, length of stay, or mortality (moderate quality). From a safety perspective, steroids resulted in a transient increase in systemic blood pressure (mean difference of 6.8 mmHg, 95% CI 4.6-8.9) (moderate quality). Weight gain during treatment was lower in the systemic steroid group (-9.2 g/day, 95% CI -11.7 to -6.8) (moderate quality), although overall growth was reported as equal (2.4 g/day, 95% CI -0.3 to 6.3) (moderate quality). One retrospective study reported the incidence of steroid treatment among infants with established BPD (any definition) to be as high as 36%. Two single-arm studies reported a prolonged high-dose systemic steroid regimen as the routine treatment strategy for severe established BPD. Conclusions: Moderate quality of evidence suggests that steroid treatment cannot be recommended as standard of care for established BPD. However, corticosteroids are often used to this end. Large-scale RCTs designed to treat BPD are urgently needed. Furthermore, careful consideration for patient selection and compliance with GRADE methodology is essential.