Meta-analysis Of Hydrocortisone Therapy For The Prevention Of Bronchopulmonary Dysplasia In Preterm Infants With Mechanical Ventilation

Objective To evaluate the efficacy and safety of hydrocortisone in preventing bronchopulmonary dysplasia in preterm infants with mechanical ventilation.Methods Computer searched for randomized controlled trial(RCT)of hydrocortisone for preventing bronchopulmonary dysplasia in premature infants,in Pubmed,Cochrane Library,Embase,CBM,CNKI,Wang Fang and VIP databases,started from the time when initial establishment of the database to October 2019.Two reviewers selected literature,extracted data and assessed the risk of bias studies independently.Statistical analysis was performed by review manager 5.2 software.Results Only 8 RCTs with 1125 cases were included.The incidence of BPD at 36 weeks of gestational age,the survival without BPD,the risk of premature death before discharge had no statistically significance.The outcomes of the RR and 95% CI were distributed as follows:1.01(0.89 ～ 1.13),1.10(0.94 ～ 1.29),0.77(0.59 ～ 1.00),P > 0.05.Premature infants under mechanically ventilated were beneficial from hydrocortisone therapy,which can shorten the mechanical ventilation time.The incidences of adverse outcomes related to hydrocortisone therapy include: gastrointestinal perforation,patent ductus arteriosus requiring drug or surgical treatment,hyperglycemia requiring insulin therapy,sepsis,necrotizing enterocolitis,intravetricular hemorrhage,periventricular leukomalacia,cerebral palsy,and neuro developmental impairment.The RR and 95%CI of the adverse outcomes above were distributed as follows: 1.50(0.89～2.52),0.91(0.79～1.05),1.30(0.87～1.93),0.96(0.86～1.06),0.83(0.57～1.22),0.96(0.86～1.08),0.97(0.69～1.36),0.97(0.70～1.36),1.00(0.55～1.82),0.89(0.64～1.25),had no statistically significant(P> 0.05).Conclusion1.Hydrocortisone therapy did not reduce the risk of BPD at PMA36 weeks for premature infants on mechanical ventilation,nor did it improve the survival chance of without BPD for premature infants at PMA36 weeks on mechanical ventilation.2.Hydrocortisone therapy did not increase the risk of short-term and long-term adverse reactions in premature infants under mechanical ventilation.3.Hydrocortisone therapy shorten the mechanical ventilation time of premature infants.