Intratracheal Administration of Budesonide-Surfactant in Prevention of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants: A Systematic Review and Meta-Analysis
Overview
Pulmonary Medicine
Affiliations
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.
Okbay Gunes A, Bozkaya A Arch Iran Med. 2024; 27(10):573-579.
PMID: 39492564 PMC: 11532653. DOI: 10.34172/aim.31725.
Beyond Bronchopulmonary Dysplasia: A Comprehensive Review of Chronic Lung Diseases in Neonates.
El-Atawi K, Abdul Wahab M, Alallah J, Osman M, Hassan M, Siwji Z Cureus. 2024; 16(7):e64804.
PMID: 39156276 PMC: 11329945. DOI: 10.7759/cureus.64804.
Strategies for the prevention of bronchopulmonary dysplasia.
Dini G, Ceccarelli S, Celi F Front Pediatr. 2024; 12:1439265.
PMID: 39114855 PMC: 11303306. DOI: 10.3389/fped.2024.1439265.
Marzban A, Mokhtari S, Tavakkolian P, Mansouri R, Jafari N, Maleki A BMC Pediatr. 2024; 24(1):262.
PMID: 38643076 PMC: 11031862. DOI: 10.1186/s12887-024-04736-9.
van de Loo M, van Kaam A, Offringa M, Doyle L, Cooper C, Onland W Cochrane Database Syst Rev. 2024; 4:CD013271.
PMID: 38597338 PMC: 11005325. DOI: 10.1002/14651858.CD013271.pub2.