Meta Analysis Of Using Glucocorticoids To Prevent Bronchopulmonary Dysplasia In Premature Infants After Birth By Different Means

Objective: Bronchopulmonary dysplasia(BPD)is one of the most common complications in preterm infants.It seriously affects the survival rate and quality of life of premature infants.The purpose of this paper is to evaluate the efficacy and safety of glucocorticoid for preventing bronchopulmonary dysplasia in preterm infants by different means.Methods: The databases including EMBASE,PUBMED,Cochrane Library,CBM,Wanfang Database,CNKI and VIP Database were searched to collect randomized controlled trials(RCT)on the use of glucocorticoids in the prevention of bronchopulmonary dysplasia in preterm infants.The search period is from the establishment of the library to December 2018.The quality of the retrieved literature is evaluated and Meta analysis is performed by using Revman 5.3 software.Results: In the end,12 randomised control trials including 3,093 children were included in the standard,with 1,544 in the control group and 1,549 in the trial group.On the base of the results of meta analysis: intravenous use of glucocorticoids[OR=0.68,95%CI(0.53,0.88),P=0.0004]and inhalation of glucocorticoids[OR=0.65,95%CI(0.50,0.85),P=0.0001]were both beneficial to reduce the incidence of BPD at 36 weeks of fetal age in premature infants.Intravenous use of glucocorticoids was beneficial to shorten mechanical ventilation time[MD=-6.00,95%CI(-6.66,-5.34),Z=17.84,P<0.00001].Intravenous use of glucocorticoids[OR=0.62,95%CI(0.48,0.80),P=0.0002]and inhalation of glucocorticoids[OR=0.60,95%CI(0.46,0.79),P=0.0002]were both beneficial to reduce the incidence of PDA,but increase the probability of hyperglycemiaand intestinal perforation.Besides,it affected the weight increase of premature infants at 36 weeks[MD=-56.82,95%CI(-94.77,-18.87),Z=2.93,P=0.003].Conclusions: 1.Intravenous use of glucocorticoids can reduce the incidence of BPD,the mechanical ventilation time and the risk of PDA.However,there are different degrees of side effects on the digestive system,endocrine system,nervous system,and growth and development.2.Inhalation of glucocorticoids can reduce the incidence of BPD and the risk of PDA,but there are certain side effects in the nervous system and growth and development.Compared with intravenous glucocorticoids,the adverse prognosis is less,but RCT are less and more clinical studies are needed.3.The effectiveness and adverse prognosis of glucocorticoid should be further studied.