Intratracheal Administration of Budesonide-Surfactant in Prevention of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants: A Systematic Review and Meta-Analysis.
Despite the near universal adaptation of gentle mechanical ventilation, surfactant use and non-invasive respiratory support, bronchopulmonary dysplasia (BPD) remains one of the most common respiratory morbidities in very low birth weight (VLBW) infants. Thus, the objective of this review was to evaluate the efficacy of intra-tracheal administration of budesonide-surfactant mixture in preventing bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants. MEDLINE, EMBASE, and PubMed were searched for randomized clinical trials in which intra-tracheal administration of budesonide-surfactant was used to prevent BPD in infants. The primary outcomes were BPD and composite outcome of death or BPD. Meta-analysis of the two clinical trials revealed that infants who received intra-tracheal instillation of budesonide-surfactant mixture demonstrated 43% reduction in the risk of BPD (RR: 0.57; 95%CI: 0.43-0.76, NNT = 5). Although mortality was not different between the groups (OR: 0.61; 95%CI: 0.34-1.04), a 40% reduction was observed in the composite outcome of death or BPD in the budesonide-surfactant group (RR: 0.60; 95%CI: 0.49-0.74, NNT = 3). Thus, this review concludes that intra-tracheal administration of budesonide-surfactant combination was associated with decreased incidence of BPD alone or composite outcome of death or BPD in VLBW infants though there is a need for larger trials before it can be recommended as a standard of care.
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
Rohini
R
Venkataraman
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
Majeeda
M
Kamaluddeen
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.|Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
Shabih U
SU
Hasan
Health Sciences Library, University of Calgary, Calgary, Alberta, Canada.
Helen Lee
HL
Robertson
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.|Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.|Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.|Department of Pediatrics, Peter Lougheed Centre, Calgary, Alberta, Canada.
Abhay
A
Lodha
D000280:Administration, Inhalation; D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control*; D019819:Budesonide / Q000008:administration & dosage* / Q000627:therapeutic use; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D011663:Pulmonary Surfactants / Q000008:administration & dosage* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000009:adverse effects; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy / Q000628:therapy
D005938:Glucocorticoids; D011663:Pulmonary Surfactants; D019819:Budesonide
bronchopulmonary dysplasia; budesonide; human and mortality; intra-tracheal; premature infant; pulmonary surfactant; randomized controlled trial