Steroid therapy for meconium aspiration syndrome in newborn infants

Abstract

Background: Meconium aspiration syndrome may cause severe respiratory distress in the newborn infant, with an associated high morbidity and mortality. A chemical pneumonitis is believed to occur secondary to bile, bile acids and pancreatic secretions contained in meconium. It has therefore been hypothesised that corticosteroids may be of benefit in the management of this condition through their anti-inflammatory properties.

Objectives: The objective of this review was to determine whether steroid therapy for meconium aspiration syndrome decreases the morbidity and mortality associated with this condition without adverse effects.

Search strategy: Searches were made of PREMEDLINE and MEDLINE from 1966 to April 2003, CINAHL back to 1982, Current Contents back to 1998, The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2003) and Oxford Database of Perinatal Trials. The search included cross-referencing of previous reviews, and a review of abstracts, conference and symposia proceedings published in Pediatric Research from 1993 to 2003.

Selection criteria: Randomised controlled trials and quasi-randomised trials comparing steroid treatment to no steroid treatment for neonates with meconium aspiration syndrome were considered for this review.

Data collection and analysis: The methodological quality of each trial was assessed independently by each author. Data were extracted, analysed and results reviewed independently by each author. Meta-analysis was performed with RevMan 4.2, using the fixed effects model. Mean difference (MD) and weighted mean differences (WMD) with 95% confidence intervals in brackets for continuous variables and Relative Risk (RR) with 95% confidence intervals for categorical data were reported.

Main results: Three randomised controlled trials were identified. Two trials, by Wu 1999 (50 participants) and Yeh 1977 (35 participants), were included in the review. The trial by Davey 1995, as yet unpublished, was excluded from this review as insufficient information about methodology and results were available. On meta-analysis, there was no significant reduction in mortality [typical RR 0.95 (0.20, 4.58)]. A small but significant increase in duration of oxygen therapy was seen with the use of steroids [WMD 30.0 hours (8.4, 51.6)]. There was no significant difference in duration of hospital stay in the study by Wu 1999 [MD 0.00 days (-3.09, 3.09)]. Duration of mechanical ventilation was reported by Wu 1999 with no significant difference seen [MD -1.10 days (-2.79, 0.59)]. Incidence of air leak was reported by Yeh 1977 with no significant difference detected [RR 0.64 (0.18, 2.26)]. Long-term outcome was not reported in either of the two studies.

Reviewer's conclusions: At present, there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome. A further large randomised controlled trial assessing potential benefits and harm would be required to determine its role.

1.1. Analysis

Comparison 1 Steroid vs placebo in the treatment of meconium aspiration syndrome, Outcome 1 Chronic lung disease (oxygen dependency at 28 days).

1.2. Analysis

Comparison 1 Steroid vs placebo in the treatment of meconium aspiration syndrome, Outcome 2 Mortality (before hospital discharge).

1.3. Analysis

Comparison 1 Steroid vs placebo in the treatment of meconium aspiration syndrome, Outcome 3 Duration of mechanical ventilation (days).

1.4. Analysis

Comparison 1 Steroid vs placebo in the treatment of meconium aspiration syndrome, Outcome 4 Duration of oxygen therapy (hours).

1.5. Analysis

Comparison 1 Steroid vs placebo in the treatment of meconium aspiration syndrome, Outcome 5 Pulmonary air leak syndrome.

1.6. Analysis

Comparison 1 Steroid vs placebo in the treatment of meconium aspiration syndrome, Outcome 6 Duration of hospital stay (days).