Hydrocortisone for Preventing Mortality and Bronchopulmonary Dysplasia in Preterm Infants with or without Chorioamnionitis Exposure: A Meta-Analysis of Randomized Trials

2020 ◽  
Author(s):  
Jianguo Zhou ◽  
Zhuowen Yu ◽  
Chao Chen
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Low Dose ◽  
Meta Analysis ◽  
Secondary Analysis ◽  
Risk Difference ◽  
Number Needed To Treat ◽  
Early Application ◽  
Infant Exposure ◽  
Significant Difference

Abstract Objective This study sought to assess whether infants exposed to chorioamnionitis are the optimal population to benefit the most from early postnatal hydrocortisone delivery in preventing bronchopulmonary dysplasia (BPD). This meta-analysis was conducted to discover the efficacy of hydrocortisone in preterm infants with and without chorioamnionitis. Study Design From the earliest available date until March 2018, studies, review articles, and papers published in PubMed, Ovid, and Web of Science were reviewed. Randomized controlled trials comparing hydrocortisone with placebo/no intervention in preterm infants with a known status of chorioamnionitis exposure were included. Result Early postpartum low-dose hydrocortisone prevents the combined outcome of neonatal BPD or death in infants weighing less than 1,000 g with chorioamnionitis exposure (odds ratio [95% confidence interval]: 0.52 [0.32–0.79]; risk difference: –0.15 [–0.24 to –0.06]; number needed to treat: 6 [4–16]) but not in infants without chorioamnionitis exposure. Further secondary analysis showed no significant difference between the hydrocortisone group and the placebo group in individual outcomes of BPD or death, regardless of infant exposure to chorioamnionitis. Conclusion Early application of low-dose hydrocortisone could potentially prevent BPD or death in infants weighing less than 1,000 g with exposure to chorioamnionitis. This finding provides the basis for further study in this target group.

scholarly journals Sustained inflations and avoiding mechanical ventilation to prevent death or bronchopulmonary dysplasia: a meta-analysis

2018 ◽  
Vol 27 (150) ◽  
pp. 180083 ◽  
Author(s):  
Hendrik S. Fischer ◽  
Georg M. Schmölzer ◽  
Po-Yin Cheung ◽  
Christoph Bührer
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Positive Pressure ◽  
Number Needed To Treat ◽  
Very Preterm Infants ◽  
Risk Of Death ◽  
Very Preterm

Sustained inflations and avoidance of endotracheal mechanical ventilation (eMV) are delivery room interventions aimed at preventing bronchopulmonary dysplasia (BPD). Their effectiveness is the subject of the present meta-analysis.The databases MEDLINE, EMBASE and CENTRAL were searched for randomised controlled trials (RCTs) of preterm infants that compared: 1) sustained inflations with intermittent positive-pressure ventilation; and 2) a non-intubated strategy of respiratory support with one that prescribed eMV at an earlier stage. Data extraction and analysis followed the standard methods of the Cochrane Collaboration. The primary outcome was death or BPD, defined as need for oxygen or positive pressure treatment at 36 weeks' postmenstrual age.Avoiding eMV (nine RCTs, 3486 infants) reduced the risk of death or BPD, with a risk ratio of 0.90 (95% CI 0.84–0.97) and a number needed to treat of 35. After sustained inflations (six RCTs, 854 infants), the risk ratio was 0.85 (95% CI 0.65–1.12). A current multicentre RCT of sustained inflations in very preterm infants was halted for increased early mortality in the sustained inflations arm.While strategies aimed at avoiding eMV had a small but significant impact on preventing BPD, sustained inflations had no effect and may even increase mortality in very preterm infants.

scholarly journals Corticosteroids for the prevention of bronchopulmonary dysplasia in preterm infants: a network meta-analysis

2018 ◽  
Vol 103 (6) ◽  
pp. F506-F511 ◽  
Author(s):  
Linan Zeng ◽  
Jinhui Tian ◽  
Fujian Song ◽  
Wenrui Li ◽  
Lucan Jiang ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Low Birthweight ◽  
Low Dose ◽  
Meta Analysis ◽  
Cochrane Library ◽  
High Dose ◽  
Extremely Preterm ◽  
Subgroup Analyses

ObjectiveTo determine the comparative efficacy and safety of corticosteroids in the prevention of bronchopulmonary dysplasia (BPD) in preterm infants.Study designWe systematically searched PubMed, EMBASE and the Cochrane Library. Two reviewers independently selected randomised controlled trials (RCTs) of postnatal corticosteroids in preterm infants. A Bayesian network meta-analysis and subgroup analyses were performed.ResultsWe included 47 RCTs with 6747 participants. The use of dexamethasone at either high dose or low dose decreased the risk of BPD (OR 0.29, 95% credible interval (CrI) 0.14 to 0.52; OR 0.58, 95% CrI 0.39 to 0.76, respectively). High-dose dexamethasone was more effective than hydrocortisone, beclomethasone and low-dose dexamethasone. Early and long-term dexamethasone at either high dose or low dose decreased the risk of BPD (OR 0.11, 95% CrI 0.02 to 0.4; OR 0.37, 95% CrI 0.16 to 0.67, respectively). There were no statistically significant differences in the risk of cerebral palsy (CP) between different corticosteroids. However, high-dose and long-term dexamethasone ranked lower than placebo and other regimens in terms of CP. Subgroup analyses indicated budesonide was associated with a decreased risk of BPD in extremely preterm and extremely low birthweight infants (OR 0.60, 95% CrI 0.36 to 0.93).ConclusionsDexamethasone can reduce the risk of BPD in preterm infants. Of the different dexamethasone regimens, aggressive initiation seems beneficial, while a combination of high-dose and long-term use should be avoided because of the possible adverse neurodevelopmental outcome. Dexamethasone and inhaled corticosteroids need to be further evaluated in large-scale RCTs with long-term follow-ups.

scholarly journals Blumgart Anastomosis After Pancreaticoduodenectomy. A Comprehensive Systematic Review, Meta-Analysis, and Meta-Regression

2021 ◽  
Author(s):  
Claudio Ricci ◽  
Carlo Ingaldi ◽  
Laura Alberici ◽  
Nico Pagano ◽  
Cristina Mosconi ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Postoperative Morbidity ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Random Effect ◽  
Reoperation Rate ◽  
Protective Role ◽  
Risk Difference ◽  
Number Needed To Treat ◽  
Secondary Endpoints

Abstract Background The superiority of Blumgart anastomosis (BA) over non-BA duct to mucosa (non-BA DtoM) still remains under debate. Methods We performed a systematic search of studies comparing BA to non-BA DtoM. The primary endpoint was CR-POPF. Postoperative morbidity and mortality, post-pancreatectomy hemorrhage (PPH), delayed gastric emptying (DGE), reoperation rate, and length of stay (LOS) were evaluated as secondary endpoints. The meta-analysis was carried out using random effect. The results were reported as odds ratio (OR), risk difference (RD), weighted mean difference (WMD), and number needed to treat (NNT). Results Twelve papers involving 2368 patients: 1075 BA and 1193 non-BA DtoM were included. Regarding the primary endpoint, BA was superior to non-BA DtoM (RD = 0.10; 95% CI: −0.16 to −0.04; NNT = 9). The multivariate ORs' meta-analysis confirmed BA's protective role (OR 0.26; 95% CI: 0.09 to 0.79). BA was superior to DtoM regarding overall morbidity (RD = −0.10; 95% CI: −0.18 to −0.02; NNT = 25), PPH (RD = −0.03; 95% CI −0.06 to −0.01; NNT = 33), and LOS (− 4.2 days; −7.1 to −1.2 95% CI). Conclusion BA seems to be superior to non-BA DtoM in avoiding CR-POPF.

scholarly journals Effectiveness of Valganciclovir 900mg Versus 450mg for Cytomegalovirus Prophylaxis in Renal Transplantation: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 20 ◽  
pp. 168 ◽  
Author(s):  
Wang Xin ◽  
Yang Hui ◽  
Zhang Xiaodong ◽  
Cui Xiangli ◽  
Wang Shihui ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Acute Rejection ◽  
Low Dose ◽  
Opportunistic Infections ◽  
Meta Analysis ◽  
High Dose ◽  
Renal Transplant Recipients ◽  
Significant Difference ◽  
Allograft Loss ◽  
Cmv Disease

Objectives: Valganciclovir 900 mg/day is approved for cytomegalovirus (CMV) prophylaxis, but 450 mg/day is seems also effective. We systematically reviewed the efficacy and safety of low-dose versus high-dose valganciclovir prophylaxis in renal transplantation recipients. Methods: An electronic search was conducted up to November 29, 2016. The primary outcomes were incidences of CMV, CMV disease, mortality and opportunistic infection. The second outcomes were acute rejection, allograft loss, adverse drug reaction (ADR). Results: 7 cohort studies, all with high quality involving (1431 patients) were included. There was no significant difference of the incidence of following CMV disease (1271 patients, odds ratio [OR] 0.74, 95% confidence interval [CI], 0.38-1.43, p=0.36), acute rejection (1343 patients, OR 0.77, 95%CI 0.53-1.14, p=0.19), allograft loss (1271 patients, OR 0.64, 95%CI 0.31-1.35, p=0.24), mortality (1271 patients, OR 0.55, 95%CI 0.20-1.47, p=0.23) and opportunistic infections (OI) (985 patients, OR 0.76, 95%CI 0.52-1.10, p=0.14) between the low-dose and the high-dose valganciclovir  prophylaxis. And no significant difference was observed for premature valganciclovir discontinuation (1010 patients, OR 0.81, 95%CI 0.52-1.25, p=0.33) and the incidence of leukopenia (1082 patients, OR 0.65, 95%CI 0.34-1.22, p=0.18) between the two regimens. Conclusion: 450 mg and 900 mg doses of valganciclovir are equipotent for CMV universal prophylaxis. CMV 450 mg prophylaxis should be used for renal transplant recipients. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

scholarly journals Laparoscopy versus mini-laparotomy peritoneal catheter insertion of ventriculoperitoneal shunts: a systematic review and meta-analysis

2016 ◽  
Vol 41 (3) ◽  
pp. E7 ◽  
Author(s):  
Mingliang He ◽  
Leping Ouyang ◽  
Shengwen Wang ◽  
Meiguang Zheng ◽  
Anmin Liu
Keyword(s):  
Systematic Reviews ◽  
Operative Time ◽  
Meta Analysis ◽  
Catheter Insertion ◽  
Cochrane Library ◽  
Number Needed To Treat ◽  
Shunt Failure ◽  
Peritoneal Catheter ◽  
Significant Difference ◽  
Mini Laparotomy

OBJECTIVE Ventriculoperitoneal (VP) shunt treatment is the main treatment method for hydrocephalus. The traditional operative approach for peritoneal catheter insertion is mini-laparotomy. In recent years, laparoscopy-assisted insertion has become increasingly popular. It seems likely that use of an endoscope could lower the incidence of shunt malfunction. However, there is no consensus about the benefits of laparoscopy-assisted peritoneal catheter insertion. METHODS A systematic search was performed using the PubMed, Embase, ScienceDirect, and Cochrane Library databases. A manual search for reference lists was conducted. The protocol was prepared according to the interventional systematic reviews of the Cochrane Handbook, and the article was written on the basis of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. RESULTS Eleven observational trials and 2 randomized controlled trials were included. Seven operation-related outcome measures were analyzed, and 3 of these showed no difference between operative techniques. The results of the meta-analysis are as follows: in the laparoscopy group, the rate of distal shunt failure was lower (OR 0.41, 95% CI 0.25–0.67; p = 0.0003), the absolute effect is 7.11% for distal shunt failure, the number needed to treat is 14 (95% CI 8–23), operative time was shorter (mean difference [MD], −12.84; 95% CI −20.68 to −5.00; p = 0.001), and blood loss was less (MD −9.93, 95% CI −17.56 to −2.31; p = 0.01). In addition, a borderline statistically significant difference tending to laparoscopic technique was observed in terms of hospital stay (MD −1.77, 95% CI −3.67 to 0.13; p = 0.07). CONCLUSIONS To some extent, a laparoscopic insertion technique could yield a better prognosis, mainly because it is associated with a lower distal failure rate and shorter operative time, which would be clinically relevant.

Human milk as a protective factor for bronchopulmonary dysplasia: a systematic review and meta-analysis

2018 ◽  
Vol 104 (2) ◽  
pp. F128-F136 ◽  
Author(s):  
Jinglan Huang ◽  
Li Zhang ◽  
Jun Tang ◽  
Jing Shi ◽  
Yi Qu ◽  
...  
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Protective Factor ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Current Evidence ◽  
Inclusion Criteria ◽  
Formula Group ◽  
Milk Feeding

ObjectiveTo summarise current evidence evaluating the effects of human milk on the risk of bronchopulmonary dysplasia (BPD) in preterm infants.DesignWe searched for studies on human milk and BPD in English and Chinese databases on 26 July 2017. Furthermore, the references of included studies were also screened. The inclusion criteria in this meta-analysis were the following: (1) preterm infants (<37 weeks); (2) human milk; (3) comparing with formula feeding; (4) the outcome included BPD; and (5) the type of study was randomised controlled trial (RCT) or cohort study.ResultA total of 17 cohort studies and 5 RCTs involving 8661 preterm infants met our inclusion criteria. The ORs and 95% CIs of six groups were as follows: 0.78 (0.68 to 0.88) for exclusive human milk versus exclusive formula group, 0.77 (0.68 to 0.87) for exclusive human milk versus mainly formula group, 0.76 (0.68 to 0.87) for exclusive human milk versus any formula group, 0.78 (0.68 to 0.88) for mainly human milk versus exclusive formula group, 0.83 (0.69 to 0.99) for mainly human milk versus mainly formula group and 0.82 (0.73 to 0.93) for any human milk versus exclusive formula group. Notably, subgroup of RCT alone showed a trend towards protective effect of human milk on BPD but no statistical significance.ConclusionBoth exclusive human milk feeding and partial human milk feeding appear to be associated with lower risk of BPD in preterm infants. The quality of evidence is low. Therefore, more RCTs of this topic are needed.

scholarly journals Decreased Mortality in Coronavirus Disease 2019 Patients Treated With Tocilizumab: A Rapid Systematic Review and Meta-analysis of Observational Studies

2020 ◽  
Author(s):  
Jishnu Malgie ◽  
Jan W Schoones ◽  
Bart G Pijls
Keyword(s):  
Side Effects ◽  
Meta Analysis ◽  
Risk Difference ◽  
World Health ◽  
Cochrane Library ◽  
Control Group ◽  
Number Needed To Treat ◽  
Receptor Antagonists ◽  
Increased Risk ◽  
Health Organization

Abstract Background We systematically reviewed the literature to answer the following research questions: (1) Does interleukin 6 (IL-6) (receptor) antagonist therapy reduce mortality in coronavirus disease 2019 (COVID-19) patients compared to patients not treated with IL-6 (receptor) antagonists; and (2) is there an increased risk of side effects in COVID-19 patients treated with IL-6 (receptor) antagonists compared to patients not treated with IL-6 (receptor) antagonists? Methods We systematically searched PubMed, PMC PubMed Central, Medline, World Health Organization COVID-19 Database, Embase, Web of Science, Cochrane Library, Emcare, and Academic Search Premier (through 30 June 2020). Random effects meta-analysis was used to pool the risk ratios and risk differences of individual studies. Risk of bias was appraised using the Methodological Index for Non-randomized Studies (MINORS) checklist. Results The search strategy retrieved 743 unique titles, of which 10 studies (all on tocilizumab [TCZ]) comprising 1358 patients were included. Nine of 10 studies were considered to be of high quality. Meta-analysis showed that the TCZ group had lower mortality than the control group. The risk ratio was 0.27 (95% confidence interval [CI], .12–.59) and the risk difference was 12% (95% CI, 4.6%–20%) in favor of the TCZ group. With only a few studies available, there were no differences observed regarding side effects. Conclusions Our results showed that mortality was 12% lower for COVID-19 patients treated with TCZ compared with those not treated with TCZ. The number needed to treat was 11, suggesting that for every 11 (severe) COVID-19 patients treated with TCZ, 1 death is prevented. These results require confirmation by randomized controlled trials.

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