Different Administration Of Budesonide For Preventing BPD:a Meta-analysis

Objective: In this study,meta-analysis(Meta analysis)was used to evaluate the clinical efficacy of intratracheal administration of budesonide(intratracheal instillation and aerosol inhalation)in the prevention of neonatal bronchopulmonary dysplasia(BPD),with emphasis on the comparison of its efficacy,safety and related complications,so as to provide a reference basis for the clinical selection of administration of budesonide to prevent neonatal BPD.Methods: By searching various literature databases,including China National Knowledge Infrastructure(CNKI),VIP Database(VIP),China Biomedical Literature Database(CBM),Wanfang Database,Pub Med,Embase,Webof Science,the Cochrane Library,and randomized controlled trials registered in China Clinical trial Registry and Clinical Trials but not published until October 31,2022,the retrieval period was from the establishment of the database to October 31,2022.A randomizedcontrolled study of intratracheal administration of budesonide was searched,,and then the literature was screened according to the inclusion and exclusion criteria.After the screening was completed,the data of the general situation and main outcome indicators of the final included literature were extracted.The main outcome indicators were effectiveness(incidence of BPD,mortality)and safety(incidence of adverse reactions).Cochrane bias risk assessment tool was used to assess bias risk.After the completion of the evaluation,the final data were combined and analyzed by Review Manager5.3 software,and the relative risk RR and the corresponding 95% confidence interval(95%Confidence Interval)were selected as the effect quantity,and the corresponding forest map was made.Finally,the funnel map corresponding to each outcome index was made by using Stata15.1 software,and the publication bias between the literature was evaluated according to whether the funnel map was symmetrical or not,so as to draw the final conclusion.Results: Through the search of various databases and Chinese and foreign clinical trial registries,a total of 2208 articles that met the inclusion criteria and 1 study that had been registered but not published before the search date were retrieved,and finally 21 articles were included.A total of 2904 children were involved(1447 in the trial group and 1457 in the control group).This paper made a statistical analysis of the relevant outcome indicators of the literature included in this study.The main outcome indicators included the incidence and mortality of BPD.Through the Meta analysis of the data included in the literature,it was concluded that the incidence of BPD in the budesonide group(RR 0.60,95% CI 0.53-0.67,p < 0.00001)was lower than that in the control group,and that in the intratracheal instillation subgroup(RR 0.57,95% CI0.49-0.67,p < 0.00001)and the aerosol inhalation subgroup(OR 0.62,95% CI0.53-0.73 p < 0.00001)were lower than those in the control group.And the difference was statistically significant.In terms of mortality,the mortality rate in the budesonide group(RR 0.80 95% CI 0.69-0.92,paired 0.002)was lower than that in the control group,and the intratracheal instillation subgroup(RR 0.59 dint 95% CI 0.40-0.87,paired 0.007)and the aerosol inhalation subgroup(RR 0.85 95% CI 0.73-0.04)were lower than those in the control group,and the difference was statistically significant.Secondary outcome indicators included the incidence of patent ductus arteriosus(PDA),retinopathy of prematurity(ROP),necrotizing enterocolitis(NEC),septicemia,intraventricular hemorrhage(IVH),periventricular leukomalacia(PVL),pulmonary hemorrhage,pneumothorax and hyperglycemia.Meta analysis of the data showed that the related complications in the budesonide group and the control group,the incidence of ROP(RR 1.06,95% CI 0.92-1.23,paired 0.4),the incidence of NEC(RR 0.93,95% CI 0.71-1.21,paired 0.58),and the incidence of septicemia(RR 0.98,95% CI0.85-1.13,paired 0.78).Incidence of IVH(RR 1.09,95% CI 0.93-1.27,pause 0.29)PVL(RR 1.18,95%CI 0.42-3.29,pause 0.76),pulmonary hemorrhage(RR 0.69,95%CI 0.38-1.24,pause 0.21),pneumothorax incidence(RR 0.86 95% CI 0.28-2.64,pause 0.79).There was no significant difference in the incidence of hyperglycemia(RR 1.12 J 95% CI 0.78-1.61,0.55).In terms of the incidence of PDA,the incidence of PDA in the budesonide group was lower than that in the control group,and the difference was statistically significant.Conclusion: 1.Intraairway administration of budesonide can reduce the incidence of BPD,mortality and the incidence of PDA.2.Intratracheal instillation of budesonide combined with PS is superior to aerosol inhalation in reducing the incidence and mortality of BPD.3.Intraairway administration of budesonide does not increase the risk of other related complications such as ROP,NEC,septicemia,IVH,PVL,pulmonary hemorrhage,pneumothorax and hyperglycemia.