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Intratracheal Administration of Budesonide‐Surfactant in Prevention of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants: A Systematic Review and Meta‐Analysis
Author(s) -
Venkataraman Rohini,
Kamaluddeen Majeeda,
Hasan Shabih U.,
Robertson Helen Lee,
Lodha Abhay
Publication year - 2017
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23680
Subject(s) - bronchopulmonary dysplasia , medicine , budesonide , low birth weight , randomized controlled trial , birth weight , pediatrics , mechanical ventilation , anesthesia , inhalation , gestational age , pregnancy , genetics , biology
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.