Inhaled versus systemic corticosteroids for the treatment of chronic lung disease in ventilated very low birth weight preterm infants

摘要: BACKGROUND Chronic lung disease (CLD) remains a serious and common problem among very low birth weight infants despite the use of antenatal steroids postnatal surfactant therapy to decrease incidence severity respiratory distress syndrome. Due their anti-inflammatory properties, corticosteroids have been widely used treat or prevent CLD. However, systemic has associated with short long-term adverse effects. Administration topically through tract might result in beneficial effects on pulmonary system fewer undesirable side OBJECTIVES To determine effect inhaled versus administered ventilator dependent preterm neonates < 1500 g gestational age 32 weeks after two life for treatment evolving SEARCH STRATEGY Randomized quasi-randomized trials were identified by searching Cochrane Central Register Controlled Trials (CENTRAL, The Library, Issue 3, 2007), MEDLINE (1966 - June EMBASE (1980 CINAHL (1982 reference lists published abstracts Pediatric Research electronically Academic Societies website (1990 April 2007). SELECTION CRITERIA comparing corticosteroid (irrespective dose duration therapy) starting first infants. DATA COLLECTION AND ANALYSIS Data extracted regarding clinical outcomes including CLD at 28 days 36 postmenstrual (PMA), mortality, combined outcome death PMA, other All data analyzed using RevMan 4.2.10. When appropriate, meta-analysis was performed relative risk (RR), difference (RD), weighted mean (WMD) along 95% confidence intervals (CI). If RD statistically significant, number needed (NNT) calculated. MAIN RESULTS from one additional trial available inclusion this update. Thus, five identified. Two excluded as both included non-ventilator patients three qualified review. Halliday et al (Halliday 2001) randomized 72 hours, while Rozycki (Rozycki 2003) Suchomski (Suchomski 2002) 12 21 days. Suchmoski are meta-analytic techniques. reported separately, measured over different time periods randomization. In none there significant between groups PMA all estimates RR 1.10 (95% CI 0.82, 1.47), 0.03 -0.08, 0.15); (n = 292). For typical 1.02 0.83, 1.25) 0.01 -0.11, 0.14); (number 139 ). There no differences either oxygen dependency age, intubation, dependence, Information neurodevelopmental not available. AUTHORS' CONCLUSIONS This review found evidence that confer net advantages management Neither nor can be recommended standard ventilated effectiveness side-effect profiles steroids. A better delivery guaranteeing selective alveoli without increasing side-effects. resolve issue, studies identify risk/benefit ratio techniques dosing schedules administration these medications. steroids, particular attention outcome, should addressed future studies.