title: Inhaled steroids for neonatal chronic lung disease.
abstract: BACKGROUND
  Bronchopulmonary dysplasia (BPD) is a chronic disorder associated with prematurity. Systemic steroids induce at least a temporary improvement in respiratory function, but are associated with adverse side effects. Inhaled steroids have fewer side effects.
  
  
  OBJECTIVE
  To determine if inhaled corticosteroids are effective in alleviating the morbidity of bronchopulmonary dysplasia (BPD) compared to 0-placebo.
  
  
  METHODS
  We identified randomised, controlled trials (RCT) within the Cochrane Database, references from retrieved trials, hand searches of journals and contact with pharmaceutical companies and experts in this field.
  
  
  METHODS
  Only randomised controlled trials involving infants with chronic lung disease of prematurity and treated with inhaled steroids versus placebo were included. Patients receiving systemic corticosteroids were excluded. Co-interventions included antenatal systemic steroids, routine neonatal intensive care, ventilatory support, surfactant replacement therapy, diuretics and bronchodilators.
  
  
  METHODS
  Four of the seven included trials were of good methodological quality. There were five parallel-group trials in ventilated infants. These were comparable in terms of population, co-interventions and need for increased inspired oxygen concentration. They differed in terms of type, dose and duration (7-28 days) of inhaled steroids. Two cross-over trials were performed in non-ventilated patients.
  
  
  RESULTS
  The inability to extubate during treatment was markedly reduced in infants treated with inhaled steroids; Peto Odds Ratio (OR) 0.12, 95% Confidence Interval (CI) 0.03 to 0.43. There was heterogeneity in this finding, however, with one study that contributed 30% of the total number of patients reporting no successful extubations in either treatment arm over one week. The risk of sepsis appeared similar between the two groups (N=3, OR=0.72, 95%CI: 0.21 to 2.43). The small number of trials precluded analysis to examine the effect of differences in drug, duration of therapy, delivery system, co-interventions, and disease severity. Reduced oxygen requirements were reported in one of the two trials performed in non-ventilated infants, but inadequate data reporting precluded pooling of data.
  
  
  CONCLUSIONS
  In ventilated infants with BPD, inhaled steroids administered for 1 to 4 weeks improved the rate of extubation with no apparent increase in the risk of sepsis. No firm conclusion could be derived with regard to the efficacy of inhaled steroids in non-ventilated infants.
authors.affiliation: PICU, Addenbrookes Hospital, Hills Road, Cambridge, UK. paulalister@homesteadbarn.freeserve.co.uk
authors.forename: P
authors.initials: P
authors.lastname: Lister
authors.forename: R
authors.initials: R
authors.lastname: Iles
authors.forename: B
authors.initials: B
authors.lastname: Shaw
authors.forename: F
authors.initials: F
authors.lastname: Ducharme
mesh_terms: D000280:Administration, Inhalation; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001997:Bronchopulmonary Dysplasia / Q000188:drug therapy*; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial; D013256:Steroids
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D013256:Steroids