Meta-analysis Of Clinical Efficacy About Glucocorticoid Trerting Meconium Aspiration Syndrome

Background: Intense chemical inflammation has been demonstrated by studies to occur secondary to several cytokines, chemokines and other chemicals contained in meconium, which is the pathophysiology foundation of glucocorticoid therapy for meconium aspiration syndrome (MAS). There have been many trials about this therapy by now, but the efficacy reported was variable,lack of latest reliable evidence from Evidence-Based Medicine (EBM).Objective: Summarizing results of trials associated with glucocorticoid therapy for MAS at home and abroad, we assessed its effectiveness and safety by Meta-analysis, in order to offer reliable evidences for clinical treatment and further investigation.Search strategy: PubMed, MEDLINE, EMBASE, EBSCOhost, the Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid, Chinese Biological Medical Literature Database (CBM), Wanfang Chinese Periodical Dataset and VIP Chinese Periodical Database were electronically searched till February 2010, supplemented by searching for literatures about glucocorticoid treatment for MAS manually.Inclusion criteria: All randomized controlled trials (RCTs) about glucocorticoid initiated within postnatal forty-eight hours in newborns with MAS were selected for this systematic review, no matter how many doses and what kind of glucocorticoid administrated.Data collection and analysis : We collected the data regarding short-term outcomes including mortality during hospitalization, hospital stays, duration of respiratory distress, duration of X-ray clearance, duration of oxygen dependence, incidence of acute complications of MAS ( include persistent pulmonary hypertension of newborn (PPHN), respiratory failure and air leak) and incidence of adverse effects of glucocorticoid in the primary hospital stays (include sepsis, oral thrush, superficial fungal infections, meningitis, hypertension, hyperglycemia and gastrointestinal hemorrhage). So was data regarding long-term outcomes including incidence of chronic lung disease and neurological sequelae (include growth and development delay, cerebral palsy and sensorineural deafness). The different statistical methods were applied according to different data types and statistical heterogenicities. Meta-analysis was made with RevMan 5.0.23 software provided by the Cochrane Collaboration. Descriptive analysis was made when Meta-analysis was not available.Results: Five RCTs enrolled with 295 participants were eligible for this systemic review, among which four was evaluated as moderate risk of bias, while the other one as high risk of bias. Interventions included inhalation of budesonide suspension by jet nebulizer system, injection of hydrocortisone through the indwelling umbilical arterial catheter, intravenous dexamethasone and intravenous methylprednisolone. Meta-analysis showed that hospital stays, duration of respiratory distress and duration of oxygen dependence in budesonide inhaled group and methylprednisolone injected group had significant difference compared to control group respectively, and that the difference of incidence of sepsis between budesonide inhaled group and controlled group also had statistically significance, and that the difference of others between glucocorticoid treated group and controlled group was not statistically significant. Descriptive analysis results indicated that incidence of PPHN, air leak, hyperglycemia, growth and development delay, hypertension and CLD between glucocorticoid treated group and controlled group had no significant difference. There was no RCT enrolled about occurrence of respiratory failure, air leak, gastrointestinal bleeding, cerebral palsy and sensorineural deafness.Conclusions: Budesonide suspension inhaled and methylprednisolone injected intravenously within postnatal forty-eight hours after in newborns with MAS can shorten hospital stays, relieve respiratory distress symptoms and shorten duration of oxygen dependence. Glucocorticoid treatment does not improve the final outcome of newborn with MAS, also does not increase incidence of glucocorticoid-related sepsis, oral thrush, other superficial fungal infection and meningitis. At present it is unable to evaluate efficacy of glucocorticoid treatment on acute and chronic complications of MAS. Reliable evidences about short-term adverse effects of glucocorticoid (include hypertension, hyperglycemia, gastrointestinal bleeding) and neurological sequelae (include cerebral palsy, growth and development delay, sensorineural deafness) are not available. Due to limited sample size and high risk of bias of RCTs enrolled, the efficacy of glucocorticoid therapy needs to be considerated with caution and demonstrated by further standardized, larger-scale, multi-center randomized controlled trials.