title: Inhaled Corticosteroids for Bronchopulmonary Dysplasia: A Meta-analysis.
abstract: Bronchopulmonary dysplasia (BPD) in preterm infants remains a major health burden despite many therapeutic interventions. Inhaled corticosteroids (IC) may be a safe and effective therapy.
  
  
  
  To assess the safety and efficacy of IC for prevention or treatment of BPD or death in preterm infants.
  
  
  
  PubMed, the Cochrane Library, Embase, and CINAHL from their inception until November 2015 together with other relevant sources.
  
  
  
  Randomized controlled trials of ICs versus placebo for either prevention or treatment of BPD.
  
  
  
  This meta-analysis used a random-effects model with assessment of quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.
  
  
  
  Thirty-eight trials were identified, and 16 met inclusion criteria. ICs were associated with a significant reduction in death or BPD at 36 weeks' postmenstrual age (risk ratio [RR] = 0.86, 95% confidence interval [CI] 0.75 to 0.99, I2= 0%, P = .03; 6 trials, n = 1285). BPD was significantly reduced (RR = 0.77, 95% CI 0.65 to 0.91, I2= 0%, 7 trials, n = 1168), although there was no effect on death (RR = 0.97, 95% CI 0.42 to 2.2, I2= 50%, 7 trials, n = 1270). No difference was found for death or BPD at 28 days' postnatal age. The use of systemic steroids was significantly reduced in treated infants (13 trials, n = 1537, RR = 0.87, 95% CI 0.76 to 0.98 I2= 3%,). No significant differences were found in neonatal morbidities and other adverse events.
  
  
  
  Long-term follow-up data are awaited from a recent large randomized controlled trial.
  
  
  
  Very preterm infants appear to benefit from ICs with reduced risk for BPD and no effect on death, other morbidities, or adverse events. Data on long-term respiratory, growth, and developmental outcomes are eagerly awaited.
authors.affiliation: Department of Neonatology, Ziv Medical Center, Faculty of Medicine in the Galil, Bar-Ilan University, Tsfat, Israel; eric.s@ziv.health.gov.il.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Shinwell
authors.affiliation: Department of Neonatology, Ziv Medical Center, Faculty of Medicine in the Galil, Bar-Ilan University, Tsfat, Israel.
authors.forename: Igor
authors.initials: I
authors.lastname: Portnov
authors.affiliation: Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité-U1153, Inserm/Université Paris Descartes, Cochrane France, Hôpital Hôtel-Dieu, Paris, France; and.
authors.forename: Joerg J
authors.initials: JJ
authors.lastname: Meerpohl
authors.affiliation: Department of Neonatology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
authors.forename: Tanja
authors.initials: T
authors.lastname: Karen
authors.affiliation: Department of Neonatology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
authors.forename: Dirk
authors.initials: D
authors.lastname: Bassler
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D001997:Bronchopulmonary Dysplasia / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones