| Objective: To evaluate the efficacy and safety of hydrocortisone(HC)in the prevention and treatment of bronchopulmonary dysplasia(BPD)by meta analysis,to explore whether HC can effectively reduce the incidence of BPD,to demonstrate its adverse side effects in the treatment process,in order to optimize the treatment plan and improve the treatment effect of BPD patients,Methods: The databases of Pub Med,Cochrane Library,EMBASE,CNKI and Wanfang were searched systematically,and the eligible studies were screened according to the inclusion criteria and exclusion criteria,so as to obtain the currently published clinical control study on hydrocortisone in the treatment of preterm infants.The design features,intervention measures,occurrence of bronchopulmonary dysplasia and serious side effects were extracted.Revman 5.3 was used to conduct a meta-analysis of the data integrated into the study.Results: A total of 20 clinical randomized controlled studies were included in this meta-analysis.The number of samples was 2305.Meta analysis results show:(1)The incidence of BPD(Relative risk(RR)= 0.97,95% confidence interval(CI)when HC is used to prevent and treat preterm infants with gestational age ? 30 weeks)= 0.86-1.09,Z = 0.56,P = 0.58> 0.05)No statistical difference;survival rate of patients without BPD(RR = 1.21,95% CI = 1.06-1.38,Z = 2.82,P = 0.0005 <0.05)There were statistical differences;the mortality of patients with BPD(RR = 0.75,95% CI =0.62-0.91,Z = 2.88,P = 0.0004 <0.05)was statistically different.(2)Short-term adverse effects of HC in the prevention and treatment of preterm infants with gestational age ? 30 weeks,compared with the control group without HC.0.05),gastrointestinal perforation(RR = 1.56,95% CI = 0.99-2.45,Z = 1.94,P = 0.05?0.05),softening of paraventricular white matter(RR = 0.71,95% CI = 0.43-1.15,Z = 1.40,P= 0.16> 0.05),intraventricular hemorrhage> II degree(RR = 0.71,95% CI = 0.43-1.15,Z = 1.40,P = 0.16> 0.05).(3)To evaluate long-term adverse effects in the prevention and treatment of HC for gestational age ? 30 weeks in preterm infants,and cerebral palsy within 1-2 years of follow-up(RR = 0.98,95% CI = 0.60-1.61,Z = 0.07,P = 0.94> 0.05)Nerve injury(RR = 0.97,95% CI = 0.77-1.22,Z = 0.24,P = 0.81>0.05),nerve injury or death(RR = 0.92,95% CI = 0.77-1.10,Z = 0.87,P = 0.39 >0.05),Bayley Mental Development Index(MDI)<70(RR = 0.73,95% CI = 0.49-1.07,Z = 1.63,P = 0.10> 0.05),Bayley MDI 70-84 for intelligence assessment(RR = 1.28,95% CI = 0.80-2.06,Z = 1.04,P = 0.30 > 0.05),Bayley MDI for intelligence assessment> 85(RR = 1.02,95% CI = 0.88-1.19,Z = 0.29,P = 0.77 > 0.05)There was no statistically significant difference in incidence.Conclusion:(1)Hydrocortisone(HC)can not effectively reduce the incidence of bronchopulmonary dysplasia(BPD)in preterm infants whose gestational age is less than 30 weeks.(2)The incidence of septicemia,paraventricular leukomalacia,gastrointestinal perforation and intraventricular hemorrhage in preterm infants with gestational age less than 30 weeks was similar to that in the control group.(3)The incidence of cerebral palsy,nerve injury,nerve injury and death,and intelligence assessment under Bailey infant development scale were similar in the preterm infants with hydrocortisone treatment less than 30 weeks and follow-up of 1-2 years. |
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