Postnatal hydrocortisone for preventing or treating bronchopulmonary dysplasia in preterm infants: a systematic review.

Abstract:

BACKGROUND:Corticosteroids have been used widely after birth in preterm infants with respiratory failure; hydrocortisone may be preferable to other corticosteroids for this purpose. OBJECTIVES:To determine if postnatal hydrocortisone is useful to prevent or treat bronchopulmonary dysplasia (BPD) in preterm infants. METHODS:Randomised controlled trials (RCTs) of postnatal hydrocortisone therapy to prevent or treat BPD were sought. Data regarding clinical outcomes including mortality, BPD, death or BPD, complications during the primary hospitalisation, and long-term outcome were abstracted and analysed using RevMan 5. RESULTS:Eight RCTs enrolling a total of 880 participants were eligible. In all trials treatment was started in the first week of life; there were no trials of treatment started in infants who were chronically ventilator-dependent after the first week of life with established or evolving BPD. A meta-analysis of the available trials demonstrated little evidence for a direct effect of hydrocortisone on the rates of BPD, mortality, or the combined outcome of BPD or mortality. Hydrocortisone in the doses used in these eight studies had few beneficial or harmful effects; the notable exception was an increase in gastrointestinal perforation. CONCLUSIONS:Postnatal hydrocortisone in the doses and regimens used in the reported trials has few beneficial or harmful effects and cannot be recommended for prevention of BPD. There are no randomised trials to substantiate the use of hydrocortisone in chronically ventilator-dependent infants with established or evolving BPD.

journal_name

Neonatology

journal_title

Neonatology

authors

Doyle LW,Ehrenkranz RA,Halliday HL

doi

10.1159/000279992

subject

Has Abstract

pub_date

2010-01-01 00:00:00

pages

111-7

issue

2

eissn

1661-7800

issn

1661-7819

pii

000279992

journal_volume

98

pub_type

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