Long-term Effects of Intratracheal Budesonide and Surfactant for the Prevention of Bronchopulmonary Dysplasia: A Narrative Review

Abstract

Objective This study aimed to compare the safety and efficacy of intratracheal administration of budesonide and surfactant with surfactant alone for bronchopulmonary dysplasia (BPD) prevention in premature infants with respiratory distress syndrome.

Study Design A literature search was performed in MEDLINE, Embase, Cochrane, ClinicalTrials.gov, and gray literature. Assessment of quality was conducted using CASP tool, ROBIS tool, and GRADE framework.

Results A systematic review and meta-analysis and three observational studies were identified. Budesonide was associated with reduced incidence and severity of BPD, reduced mortality, patent ductus arteriosus, need for additional surfactant doses, hypotension, duration of invasive ventilation, hospital stays, salbutamol prescriptions, and hospitalizations in the first 2 years of life. The safety of budesonide on neurodevelopmental outcomes at 2 to 3 years of corrected age was reported.

Conclusion Budesonide might be associated with a reduction in BPD incidence and severity, without evidence of impaired neurodevelopment at 2 to 3 years of age. According to the GRADE framework, the level of evidence is low due to significant heterogeneity of studies and other bias.

Key Points

• BPD prevention is urgently needed.

• Intratracheal budesonide and surfactant for neonatal RDS could reduce BPD.

• The grade of evidence for this intervention is low due to study heterogeneity and other bias.

Keywords

infant - premature - hyaline membrane disease - chronic lung disease - steroid

Note

Part of the research conducted for this paper was included in a dissertation successfully submitted to the School of Health Sciences, University of Southampton, in partial fulfilment of the award of the MSc Neonatology.

Publication History

Received: 02 March 2023

Accepted: 28 April 2023

Article published online:
06 June 2023

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