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Postnatal Hydrocortisone for Preventing or Treating Bronchopulmonary Dysplasia in Preterm Infants: A Systematic ReviewDoyle L.W.a · Ehrenkranz R.A.b · Halliday H.L.c
aDepartments of Obstetrics and Gynaecology, and Paediatrics, University of Melbourne, Royal Women’s Hospital, and Murdoch Children’s Research Institute, Parkville, Vic., Australia; bDepartment of Pediatrics, Yale University School of Medicine, New Haven, Conn., USA; cDepartment of Child Health, Queen’s University Belfast, and Perinatal Medicine, Royal Jubilee Maternity Service, Belfast, UK Corresponding Author
Prof. Lex W. Doyle
Department of Obstetrics and Gynaecology, The Royal Women’s Hospital
20 Flemington Rd
Parkville, Vic. 3052 (Australia)
Tel. +61 3 8345 3716, Fax +61 3 8345 3702, E-Mail email@example.com
Background: Corticosteroids have been used widely after birth in preterm infants with respiratory failure; hydrocortisone may be preferable to other corticosteroids for this purpose. Objectives: To determine if postnatal hydrocortisone is useful to prevent or treat bronchopulmonary dysplasia (BPD) in preterm infants. Methods: Randomised controlled trials (RCTs) of postnatal hydrocortisone therapy to prevent or treat BPD were sought. Data regarding clinical outcomes including mortality, BPD, death or BPD, complications during the primary hospitalisation, and long-term outcome were abstracted and analysed using RevMan 5. Results: Eight RCTs enrolling a total of 880 participants were eligible. In all trials treatment was started in the first week of life; there were no trials of treatment started in infants who were chronically ventilator-dependent after the first week of life with established or evolving BPD. A meta-analysis of the available trials demonstrated little evidence for a direct effect of hydrocortisone on the rates of BPD, mortality, or the combined outcome of BPD or mortality. Hydrocortisone in the doses used in these eight studies had few beneficial or harmful effects; the notable exception was an increase in gastrointestinal perforation. Conclusions: Postnatal hydrocortisone in the doses and regimens used in the reported trials has few beneficial or harmful effects and cannot be recommended for prevention of BPD. There are no randomised trials to substantiate the use of hydrocortisone in chronically ventilator-dependent infants with established or evolving BPD.
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