Meta AnalysisID 7206
全身性氢化可的松预防早产儿支气管肺发育不良的有效性和安全性：系统评价与Meta分析
CRD42023448112
Bronchopulmonary dysplasia (BPD) remains a common complication of preterm birth. Corticosteroids as potent anti-inflammatory agents could be of use in reducing the risk of developing BPD. Dexamethasone, a powerful glucoc
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Record Fields
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- Meta Analysis Id
- 7206
- Evidence Id
- 15764
- Core Evidence Id
- 15764
- Source Meta Analysis Id
- 7193
- Herb2 Meta Analysis Id
- HBMA007193
- Crd Id
- CRD42023448112
- Title
- Efficacy and safety of systemic hydrocortisone for the prevention of bronchopulmonary dysplasia in preterm infants: a systematic review and meta-analysis
- Review Question
- Bronchopulmonary dysplasia (BPD) remains a common complication of preterm birth. Corticosteroids as potent anti-inflammatory agents could be of use in reducing the risk of developing BPD. Dexamethasone, a powerful glucocorticoid, became widely used in the 1990s after reports of short term respiratory benefit. Use declined when adverse effects emerged, particularly neurodevelopmental effects such as cognitive impairment and cerebral palsy. Systemic hydrocortisone has been postulated as a potentially safer drug to use in terms of long-term neurodevelopment. However, randomized trials of hydrocortisone involving human infants are limited.
- Study Type Included
- Prospective RCTs involving preterm infants were eligible for inclusion in the review.
- Condition Being Studied
- Bronchopulmonary dysplasia remains prevalent after extremely preterm birth，and has not decreased over time. Its cause is multifactorial：prematurity, mechanical ventilation, oxygen exposure, and inflammation are postulated to contribute to its development. Dexamethasone, a powerful glucocorticoid, became widely used now, however, use declined when adverse effects emerged, particularly neurodevelopmental effects such as cognitive impairment and cerebral palsy. Dexamethasone is not an ideal therapeutic agent, hydrocortisone has several potentially advantageous qualities, however, randomized trials of hydrocortisone involving human infants are limited, furthermore, the optimal dose and duration of hydrocortisone use is not yet known. This trial will undertaken to determine both the efficacy of hydrocortisone in increasing survival without bronchopulmonary dysplasia and its longer-term or short-term safety.
- Participant
- Preterm infants (<32weeks)
- Animal
- Human Disease Modelled
- Intervention
- Systemic use of hydrocortisone
- Comparator Control
- Placebo
- Main Outcome
- The primary outcome included both efficacy (survival without BPD at 36 weeks of postmenstrual age) and safety measures (survival without moderate or severe neurodevelopmental impairment at 22 to 26 months). Measures of effect Statistical analysis was conducted using Review Manager (RevMan) version 5.3. For continuous outcomes, the mean and standard deviation (SD) reported in each study were collected and analysed and presented as mean differences (MD) along with 95% confidence intervals (CIs). For categorical outcomes (such as survival or BPD), data was extracted for each intervention group for analysis and presented as risk ratio (RRs) with 95% CI.
- Outcome Measure
- Additional Outcome
- Our analysis includes data from four extra studies, one using early hydrocortisone and using late hydrocortisone, one using small hydrocortisone and large hydrocortisone. Specific adverse events: Cerebral palsy; Gastrointestinal; Intraventricular haemorrhage; Neurodevelopmental impairment; Necrotising enterocolitis; Patent ductus arteriosus; Periventricular leucomalacia; Retinopathy of prematurity. Measures of effect Studies were grouped according to whether hydrocortisone was started early, or late, small;or large and separate analyses were conducted for each group.. For categorical outcomes , data was extracted for each intervention group for analysis and presented as risk ratio (RRs) with 95% CI.A prespecified sub-group analysis was conducted by including studies in which hydrocortisone was used for the prevention of BPD .Significance was set at p < 0.05.
- Study Method
- Meta-analysis, Systematic review
- Keyword
- Adrenal Cortex Hormones; Anti-Inflammatory Agents; Bronchopulmonary Dysplasia; Female; Glucocorticoids; Humans; Hydrocortisone; Iatrogenic Disease; Infant; Infant, Newborn; Infant, Premature; Premature Birth; Randomized Controlled Trials as Topic
- Contact
- Lihong [email protected]
- Organisational Affiliation
- North SiChuan Medical College No. 1, South Maoyuan Road, Shunqing District, Nanchong City, Sichuan Province
- Funding Source
- Other Selection Criteria
- Final Publication
- Same Topic Review
- Published Protocol
- Review Type
- Language
- English
- Country
- China
- Review Stage
- Review Ongoing
- First Submission Date
- 2023-07-24
- Registration Date
- 2023-09-04
- Anticipated Start Date
- 2023-07-25
- Anticipated Completion Date
- 2024-01-31
- Title Cn
- 全身性氢化可的松预防早产儿支气管肺发育不良的有效性和安全性：系统评价与Meta分析
- Title En
- Efficacy and safety of systemic hydrocortisone for the prevention of bronchopulmonary dysplasia in preterm infants: a systematic review and meta-analysis
- Bilingual Status
- complete