Thiazides And Spironolactone For Preterm Infants With Bronchopulmonary Dysplasia: A Meta-analysis

Objective To assess the pulmonary function, clinical outcomes andsafety of thiazides and spironolactone treatment for preterm infants withbronchopulmonary dysplasia(BPD).Methods The literatures related to clinical randomized controlledtrials (RCTs) on thiazides and spironolactone treating BPD among PubMed,MEDLINE, EMBASE, the Cochrane Controlled Trials Register (CCTR),Chinese Biological Medical Literature Database (CBM), VIP and Wanfangdatabase were electronically searched from the establishment of the databasetill April2013. The standard methods of the Cochrane Collaboration wereemployed to evaluate methodological quality and RevMan5.0.23softwarewas used for meta-analysis.Results Finally5studies (n=148) were included in the analysis.Meta-analysis showed that the combination of thiazides and spironolactonesignificantly increased dynamic pulmonary complianc(eSMD=0.65，95%CI:0.13~1.18，P=0.02), meta-analysis in subgroups indicated that this effect was significant in1~2weeks and4~5weeks, but not in8~10weeks. Despitethere was no significant difference on airway resistance in either group, theresult of subgroups showed that thiazides and spironolactone significantlydecreased airway resistance in1~2weeks(MD=-27.39，95%CI:-37.84~-16.95，P<0.00001). Simultaneously, the use of thiazides in combinationwith spironolactone significantly decreased mortality (RR=0.30，95%CI:0.09~0.93，P=0.04)and fraction of inspiratory oxygen(MD=-0.05，95%CI:-0.09~-0.01，P=0.03). However, it had no significant effect on theincidence of required ventilation, the duration of supplemental oxygen, thehospital stays as well as the incidence of rehospitalizations for respiratorydeterioration. Although it significantly reduced serum sodium concentration(MD=-2.22，95%CI:-3.18~-1.26，P<0.00001), urinarycalciumexcretionrate(MD=-1.46，95%CI:-2.67~-0.24，P=0.02)and elevated the incidenceof electrolyte supplement(RR=1.70，95%CI:1.12~2.57，P=0.01), therewere no statistical differences on serum potassium concentration, fluidintake, the incidence of nephrocalcinosis and hearing deficit.Conclusions Thiazides and spironolactone for BPD in preterminfants can improve pulmonary function in short term and reduce mortalityand fraction of inspiratory oxygen. Concurrently, we should pay attention tofluid and electrolyte balance. Because of limited quantity and quality of thetrials enrolled in the study, more long term follow-up RCT studies areneeded.