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Effectiveness and safety of early combined utilization of budesonide and surfactant by airway for Bronchopulmonary dysplasia prevention in premature infants with RDS: A meta-analysis
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  • Wei Tang,
  • Dongmei Shi,
  • Tao Ai,
  • Lei Zhang,
  • Yijie Huang,
  • Yinghong Fan,
  • Yiting Du
Wei Tang
Chengdu Women's and Children's Central Hospital
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Dongmei Shi
Chongqing Medical University Affiliated Children's Hospital
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Tao Ai
Chengdu Women's and Children's Central Hospital
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Lei Zhang
Chengdu Women's and Children's Central Hospital
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Yijie Huang
Chengdu Women's and Children's Central Hospital
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Yinghong Fan
Chengdu Women's and Children's Central Hospital
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Yiting Du
Chengdu Women's and Children's Central Hospital
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Abstract

Objective: To address the effectiveness and safety of early airway utilization of budesonide and surfactant for BPD prevention in premature infants with RDS. Methods: PubMed, Web of Science, EMBASE, Cochrane Library, Wanfang, CQ VIP and China National Knowledge Infrastructure databases were searched from the inception to May 2021. Stata 16.0 software was used for statistical analysis. Results: This meta-analysis suggested that early combined utilization of budesonide and surfactant by airway tended to have a superiority on BPD incidence (RR=0.63;95%CI:0.54~0.73, P<0.001), mortality (RR=0.63;95%CI:0.43~0.94, P=0.022) and the composite outcome of BPD or mortality (RR=0.59;95%CI:0.49~0.70, P<0.001), the reuse incidence of surfactant (RR=0.54; 95%CI:0.45~0.65, P<0.001), the duration of assisted ventilation (SMD=-1.14;95%CI: -1.58 ~ -0.70, P<0.001), invasive ventilation (SMD=-1.33;95%CI: -1.76~-0.90, P<0.001), and hospital stays (SMD=-1.20;95%CI: -1.88~-0.51, P=0.001) in preterm infants with RDS. And these benefits were not associated with increased adverse outcomes. Furthermore, a decreased incidence of PDA (RR=0.80; 95%CI:0.64~0.99, P=0.041) was found in test group. Subgroup analysis based on budesonide delivery methods (inhalation or intratracheal instillation) indicated that the decrease of mortality (RR=0.62;95%CI:0.41~0.95, P=0.026), duration of assisted ventilation (SMD=-0.95;95%CI: -1.30~-0.61, P<0.001) and hospital stays (SMD=-1.38;95%CI: -2.33~-0.43, P=0.004) were mainly in budesonide intratracheal instillation subgroup. Conclusions: This meta-analysis suggested that early combined utilization of budesonide and surfactant by airway might be an effective and safe clinical practice for BPD prevention in premature infants with RDS, especially when budesonide was delivered by intratracheal instillation.

Peer review status:IN REVISION

03 Jul 2021Submitted to Pediatric Pulmonology
05 Jul 2021Assigned to Editor
05 Jul 2021Submission Checks Completed
05 Jul 2021Reviewer(s) Assigned
28 Jul 2021Review(s) Completed, Editorial Evaluation Pending
02 Aug 2021Editorial Decision: Revise Major
12 Sep 20211st Revision Received