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Review
. 2024 Feb 14:12:1344337.
doi: 10.3389/fped.2024.1344337. eCollection 2024.

Outcomes of postnatal systemic corticosteroids administration in ventilated preterm newborns: a systematic review of randomized controlled trials

Giovanni Boscarino  1 , Viviana Cardilli  1 , Maria Giulia Conti  1 , Federica Liguori  1 , Paola Repole  1 , Pasquale Parisi  2 , Gianluca Terrin  1
Affiliations
Review

Outcomes of postnatal systemic corticosteroids administration in ventilated preterm newborns: a systematic review of randomized controlled trials

Giovanni Boscarino et al. Front Pediatr. .

Abstract

Introduction: Prolonged mechanical ventilation, commonly used to assist preterm newborns, increases the risk of developing bronchopulmonary dysplasia (BPD). In recent decades, studies have demonstrated that systemic corticosteroids play a significant role in the prevention and management of BPD. In this systematic review of randomized controlled trials (RCTs), we evaluated the association between the administration of systemic corticosteroids in preterm infants and its long-term outcomes, such as neurodevelopment, growth, extubation rate, and related adverse effects.

Methods: We conducted an electronic search in Medline, Scopus, and PubMed using the following terms: "premature infants" and "corticosteroids." We considered all RCTs published up to June 2023 as eligible. We included all studies involving preterm newborns treated with systemic corticosteroids and excluded studies on inhaled corticosteroids.

Results: A total of 39 RCTs were evaluated. The influence of steroids administered systemically during the neonatal period on long-term neurological outcomes remains unknown, with no influence observed for long-term growth. The postnatal administration of systemic corticosteroids has been found to reduce the timing of extubation and improve respiratory outcomes. Dexamethasone appears to be more effective than hydrocortisone, despite causing a higher rate of systemic hypertension and hyperglycemia. However, in the majority of RCTs analyzed, there were no differences in the adverse effects related to postnatal corticosteroid administration.

Conclusion: Dexamethasone administered during the neonatal period appears to be more effective than hydrocortisone in terms of respiratory outcomes; however, caution should be taken when administering dexamethasone. Data derived from current evidence, including meta-analyses, are inconclusive on the long-term effects of the administration of systemic steroids in preterm infants or the possibility of neurodevelopmental consequences.

Keywords: dexamethasone; extubation; growth; hydrocortisone; hyperglycemia; neurodevelopment; pulmonary outcome; systemic hypertension.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
PRISMA flow-chart. RCTs, randomized controlled trials.
Figure 2
Figure 2
Graphical representation of the randomized controlled trials that evaluated the outcomes of the systematic review. RCTs, randomized controlled trials; BPD, bronchopulmonary dysplasia; HG, hyperglycemia; NDV, neurodevelopment; §, at least one between patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis (or gastrointestinal perforation) and retinopathy of prematurity.
Figure 3
Figure 3
Risk of bias of the evaluated randomized controlled trials.
See this image and copyright information in PMC

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