Abstract：
BACKGROUND: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of inhaled corticosteroids (budesonide, beclomethasone, or fluticasone propionate) in preventing bronchopulmonary dysplasia (BPD) for premature infants.
METHODS: Electronic databases, including PubMed, EMBASE, Web of science, Scopus, and Cochrane library, were searched from databases inception to January 2022 for eligible randomized controlled trials. Clinical outcomes such as BPD, mortality, BPD or death, adverse events, and neurodevelopmental outcomes were assessed.
RESULTS: Overall, budesonide was significantly associated with a reduction in BPD at 36 weeks\' postmenstrual age (RR 0.48; 95 % CI [0.38, 0.62]) and patent ductus arteriosus (PDA) (RR 0.75; 95 % CI [0.63, 0.89]) compared with control treatments. Early longer duration inhalation of budesonide alone was associated with a lower risk of BPD at 36 weeks\' postmenstrual age and PDA compared with controls. Early shorter duration intratracheal instillation of budesonide with surfactant as vehicle was associated with a lower risk of BPD at 36 weeks\' postmenstrual age and all-cause mortality compared with surfactant. There was no statistically significant difference between budesonide and control groups regarding neurodevelopmental impairment. Beclomethasone and fluticasone propionate did not show any superior or inferior effect on clinical outcomes compared to control treatments.
CONCLUSIONS: These findings suggest that budesonide, especially intratracheal instillation of budesonide using surfactant as a vehicle, is a safe and effective option in preventing BPD for preterm infants. More well-design large-scale trials with long-term follow-ups are necessary to verify the present findings.
METHODS: Electronic databases, including PubMed, EMBASE, Web of science, Scopus, and Cochrane library, were searched from databases inception to January 2022 for eligible randomized controlled trials. Clinical outcomes such as BPD, mortality, BPD or death, adverse events, and neurodevelopmental outcomes were assessed.
RESULTS: Overall, budesonide was significantly associated with a reduction in BPD at 36 weeks\' postmenstrual age (RR 0.48; 95 % CI [0.38, 0.62]) and patent ductus arteriosus (PDA) (RR 0.75; 95 % CI [0.63, 0.89]) compared with control treatments. Early longer duration inhalation of budesonide alone was associated with a lower risk of BPD at 36 weeks\' postmenstrual age and PDA compared with controls. Early shorter duration intratracheal instillation of budesonide with surfactant as vehicle was associated with a lower risk of BPD at 36 weeks\' postmenstrual age and all-cause mortality compared with surfactant. There was no statistically significant difference between budesonide and control groups regarding neurodevelopmental impairment. Beclomethasone and fluticasone propionate did not show any superior or inferior effect on clinical outcomes compared to control treatments.
CONCLUSIONS: These findings suggest that budesonide, especially intratracheal instillation of budesonide using surfactant as a vehicle, is a safe and effective option in preventing BPD for preterm infants. More well-design large-scale trials with long-term follow-ups are necessary to verify the present findings.
摘要：
背景：本系统综述和荟萃分析旨在评估吸入性皮质类固醇的疗效和安全性（布地奈德，倍氯米松,或丙酸氟替卡松）预防早产儿支气管肺发育不良（BPD）。
方法：电子数据库，包括PubMed,EMBASE,WebofScience,Scopus,和Cochrane图书馆,从数据库开始到2022年1月进行搜索，寻找符合条件的随机对照试验。临床结果如BPD，死亡率,BPD或死亡，不良事件,并对神经发育结局进行评估.
结果：总体而言，与对照治疗相比，布地奈德与月经后36周龄时BPD(RR0.48;95%CI[0.38,0.62])和动脉导管未闭(PDA)(RR0.75;95%CI[0.63,0.89])降低显著相关。与对照组相比，早期长期吸入布地奈德与月经后36周龄和PDA发生BPD的风险较低相关。与表面活性剂相比，早期较短持续时间的气管内滴注布地奈德和表面活性剂作为载体与月经后36周龄时的BPD风险和全因死亡率较低相关。布地奈德组和对照组在神经发育障碍方面没有统计学上的显着差异。与对照治疗相比，倍氯米松和丙酸氟替卡松对临床结果没有任何优越或低劣的影响。
结论：这些研究结果表明，布地奈德，尤其是气管内滴注布地奈德使用表面活性剂作为载体，是预防早产儿BPD的安全有效选择。为了验证目前的发现，有必要进行更精心设计的大规模试验和长期随访。
方法：电子数据库，包括PubMed,EMBASE,WebofScience,Scopus,和Cochrane图书馆,从数据库开始到2022年1月进行搜索，寻找符合条件的随机对照试验。临床结果如BPD，死亡率,BPD或死亡，不良事件,并对神经发育结局进行评估.
结果：总体而言，与对照治疗相比，布地奈德与月经后36周龄时BPD(RR0.48;95%CI[0.38,0.62])和动脉导管未闭(PDA)(RR0.75;95%CI[0.63,0.89])降低显著相关。与对照组相比，早期长期吸入布地奈德与月经后36周龄和PDA发生BPD的风险较低相关。与表面活性剂相比，早期较短持续时间的气管内滴注布地奈德和表面活性剂作为载体与月经后36周龄时的BPD风险和全因死亡率较低相关。布地奈德组和对照组在神经发育障碍方面没有统计学上的显着差异。与对照治疗相比，倍氯米松和丙酸氟替卡松对临床结果没有任何优越或低劣的影响。
结论：这些研究结果表明，布地奈德，尤其是气管内滴注布地奈德使用表面活性剂作为载体，是预防早产儿BPD的安全有效选择。为了验证目前的发现，有必要进行更精心设计的大规模试验和长期随访。
