The cost of serial cerebrospinal fluid aspirations between ventricular access device (VAD) and ventriculosubgaleal shunt (VSGS) for treatment of post-hemorrhagic ventricular dilatation (PHVD) in premature infants

2022 ◽  
Author(s):  
Grace Y. Lai ◽  
Nathan Shlobin ◽  
Lu Zhang ◽  
Annie B. Wescott ◽  
Sandi K. Lam
Keyword(s):  
Preterm Infants ◽  
Meta Analysis ◽  
Ventricular Dilatation ◽  
Cochrane Library ◽  
Ventriculosubgaleal Shunt ◽  
Ventricular Access Device ◽  
Ventricular Puncture ◽  
Protocol Cost ◽  
The Cost ◽  
Fee Schedule

Introduction: Ventriculosubgaleal shunts (VSGS) require fewer cerebrospinal (CSF) aspirations than ventricular access devices (VAD) for temporization of post-hemorrhagic ventricular dilatation (PHVD) in preterm infants. Cost of postoperative CSF aspiration has not been quantified. Methods: We reviewed CSF aspiration and laboratory studies obtained in preterm infants with PHVD and VAD at our institution between 2009-2020. Cost per aspiration was calculated for materials, labs, and Medicare fee schedule for ventricular puncture through implanted reservoir. We searched PubMed, Cochrane Library, Embase, CINAHL, and Web of Science for meta-analysis of pooled mean number of CSF aspirations and proportion of patients requiring aspiration. Results: Thirty-five preterm infants with PHVD had VAD placed with 22.2±18.4 aspirations per patient. Labs were obtained after every aspiration per local protocol. Cost per aspiration at our institution was $935.51. Of 269 published studies, 77 reported on VAD, 29 VSGS, and 13 both. Five studies on VAD (including the current study) had a pooled mean of 25.8 aspirations per patient (95%CI:16.7-34.8). One study on VSGS reported a mean of 1.6±1.7 aspirations. 3 studies on VAD (including the current study) had a pooled proportion of 97.4% of patients requiring aspirations (95%CI: 87.9-99.5). Four studies on VSGS had a pooled proportion of 36.5% requiring aspirations (95%CI:26.9-47.2). Frequency of lab draws ranged from weekly to daily. Based on costs at our institution, mean number of aspirations, and proportion of patients requiring aspirations, cost difference ranged between $4,243 to $23,235 per patient and $500,903 to 2.36 million per 100 patients depending on frequency of taps and Medicare locality. Discussion/Conclusion: Lower number of CSF aspirations using VSGS can be associated with considerably lower cost compared to VAD.

Effect of Oral Motor Intervention on Oral Feeding in Preterm Infants: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-11
Author(s):  
Danna Chen ◽  
Zhen Yang ◽  
Chujie Chen ◽  
Pu Wang
Keyword(s):  
Weight Gain ◽  
Hospital Stay ◽  
Preterm Infants ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Oral Feeding ◽  
Transition Time ◽  
Cochrane Library ◽  
Oral Motor ◽  
Feeding Efficiency

Objective This review article aimed to explore the effect of oral motor intervention on oral feeding in preterm infants through a meta-analysis. Method Eligible studies were retrieved from four databases (PubMed, Embase, Cochrane Library, and Web of Science) up to July 2020 and screened based on established selection criteria. Thereafter, relevant data were extracted and heterogeneity tests were conducted to select appropriate effect models according to the chi-square test and I 2 statistics. Assessment of risk of bias was performed among the included studies. Finally, a meta-analysis was carried out to evaluate the effect of oral motor intervention in preterm infants according to four clinical indicators: transition time for oral feeding, length of hospital stay, feeding efficiency, and weight gain. Results Eighteen randomized controlled trials with 848 participants were selected to evaluate the effect of oral motor intervention on preterm infants. The meta-analysis results revealed that oral motor intervention could effectively reduce the transition time to full oral feeds and the length of hospital stay as well as increase feeding efficiency and weight gain. Conclusions Oral motor intervention was an effective way to improve oral feeding in preterm infants. It is worthy to be used widely in hospitals to improve the clinical outcomes of preterm infants and reduce the economic burdens of families and society. Future studies should seek to identify detailed intervention processes and intervention durations for clinical application.

Heated Humidified High-Flow Nasal Cannula for Preterm Infants: An Updated Systematic Review and Meta-analysis

2019 ◽  
Vol 35 (4) ◽  
pp. 298-306 ◽  
Author(s):  
Nigel Fleeman ◽  
Yenal Dundar ◽  
Prakesh S Shah ◽  
Ben NJ Shaw
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Primary Outcome ◽  
Meta Analysis ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Cochrane Library ◽  
High Flow Nasal Cannula ◽  
Safe Alternative

AbstractBackgroundHeated humidified high-flow nasal cannula (HHHFNC) is gaining popularity as a mode of respiratory support. We updated a systematic review and meta-analyses examining the efficacy and safety of HHHFNC compared with standard treatments for preterm infants. The primary outcome was the need for reintubation for preterm infants following mechanical ventilation (post-extubation analysis) or need for intubation for preterm infants not previously intubated (analysis of primary respiratory support)MethodsWe searched PubMed, MEDLINE, Embase, and the Cochrane Library for randomized controlled trials (RCTs) of HHHFNC versus standard treatments. Meta-analysis was conducted using Review Manager 5.3.ResultsThe post-extubation analysis included ten RCTs (n = 1,201), and the analysis of primary respiratory support included ten RCTs (n = 1,676). There were no statistically significant differences for outcomes measuring efficacy, including the primary outcome. There were statistically significant differences favoring HHHFNC versus nasal cannula positive airway pressure (NCPAP) for air leak (post-extubation, risk ratio [RR] 0.29, 95 percent confidence interval [CI] 0.11 to 0.76, I2 = 0) and nasal trauma (post-extubation: 0.35, 95 percent CI 0.27 to 0.46, I2 = 5 percent; primary respiratory support: RR 0.52, 95 percent CI 0.37 to 0.74; I2 = 27 percent). Studies, particularly those of primary respiratory support, included very few preterm infants with gestational age (GA) <28 weeks.ConclusionsHHHFNC may offer an efficacious and safe alternative to NCPAP for some infants but evidence is lacking for preterm infants with GA ≤28 weeks.

scholarly journals A systematic review protocol for examining 30-day readmission costs for atrial fibrillation patients

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e032101
Author(s):  
Taylor-Jade Woods ◽  
Peter Speck ◽  
Billingsley Kaambwa
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Meta Analysis ◽  
Primary Diagnosis ◽  
Index Admission ◽  
Cochrane Library ◽  
Forest Plot ◽  
Study Results ◽  
Meta Analyses ◽  
The Cost

IntroductionAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia and readmissions of AF patients place a huge burden on the healthcare system, including economically. With an increasing prevalence, the burden of AF will continue evolving. To illuminate the readmission-specific economic burden, we aim to provide quality evidence on the cost of readmissions within 30 days where AF has been the primary diagnosis at the index admission.Methods and analysisWe will conduct a systematic review of all peer-reviewed articles examining readmission costs for AF patients. We will search MedLine, Cumulative Index to Nursing and Allied Health Literature, Scopus and Cochrane Library for articles written in English, published in peer-reviewed journals from inception to 2019. Reporting of this protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols checklist. Studies will be included if patients were aged 18 years and over, AF was the primary diagnosis of index admission and costs of readmission within 30 days were reported. Quality assessment of studies will be done using a modified Evers checklist. Study results will be summarised in a Forest plot and heterogeneity tested for using the Cochran’s Q and I2statistic. A random-effects model will be applied for meta-analysis if studies are sufficiently homogeneous. The cost of readmission to hospital within 30 days for AF patients is the main outcome of interest while additional outcomes are 30-day readmission rate, predictors of readmission and predictors of readmission costs.Ethics and disseminationFormal ethical approval is not required as no patients will be involved. Dissemination of results will be through a peer-reviewed publication.PROSPERO registration numberCRD42019132017

scholarly journals Are Surgical Patients Satisfied With Remote Consultations? A Comparison of Remote Versus Conventional Outpatient Clinic Follow-Up for Surgical Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 ◽  
pp. 237437352110359
Author(s):  
Emily V Oates ◽  
Grace H C Lim ◽  
Edward J Nevins ◽  
Venkatesh Kanakala
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Surgical Patients ◽  
Cochrane Library ◽  
Surgical Patient ◽  
Controlled Trials ◽  
Analysis Model ◽  
Randomized Controlled ◽  
The Cost

Access to remote appointments (RA) by telephone or video is increasing as technology advances and becomes more available to patients. This meta-analysis of randomized controlled trials (RCTs) aims to discover whether surgical patients are satisfied with RAs when compared with conventional outpatient clinics (OPC). A literature search of RCTs of surgical patient satisfaction of RAs versus OPC appointments was performed. The PubMed, EMBASE, OVID, Cochrane Library, and Google Scholar databases were searched to include articles from January 2000 to 2020. A random-effects meta-analysis model was used to compare outcomes. All 7 RCTs showed that patients were as satisfied with RAs as OPC appointments (RR = 1.00, [0.98-1.02]; P = .73). Furthermore, both patient cohorts would prefer RAs for future follow-up (RR = 2.29, [1.96-2.97]; P < .00001). One RCT found the cost to institutions was less in the RA group ($19.05 vs $52.76) and another found the patients would save $9.96 on transportation costs. The majority of RCTs suggested cost to patients and or institutions would be less for RA. In conclusion, surgical patients are satisfied with RAs and in fact would prefer them.

Predictors of extubation readiness in preterm infants: a systematic review and meta-analysis

2018 ◽  
Vol 104 (1) ◽  
pp. F89-F97 ◽  
Author(s):  
Wissam Shalish ◽  
Samantha Latremouille ◽  
Jesse Papenburg ◽  
Guilherme Mendes Sant’Anna
Keyword(s):  
Preterm Infants ◽  
Spontaneous Breathing ◽  
Web Of Science ◽  
Meta Analysis ◽  
Optimal Strategies ◽  
Population Characteristics ◽  
Assessment Tools ◽  
Cochrane Library ◽  
Spontaneous Breathing Trials ◽  
Successful Extubation

ContextA variety of extubation readiness tests have already been incorporated into clinical practice in preterm infants.ObjectiveTo identify predictor tests of successful extubation and determine their accuracy compared with clinical judgement alone.MethodsMEDLINE, Embase, PubMed, Cochrane Library and Web of Science were searched between 1984 and June 2016. Studies evaluating predictors of extubation success during a period free of mechanical inflations in infants less than 37 weeks’ gestation were included. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. After identifying and describing all predictor tests, pooled sensitivity and specificity estimates for the different test categories were generated using a bivariate random-effects model.ResultsThirty-five studies were included, showing wide heterogeneities in population characteristics, methodologies and definitions of extubation success. Assessments ranged from a few seconds to 24 hours, provided 0–6 cmH2O positive end-expiratory pressure and measured several clinical and/or physiological parameters. Thirty-one predictor tests were identified, showing good sensitivities but low and variable specificities. Given the high variation in test definitions across studies, pooling could only be performed on a subset. The commonly performed spontaneous breathing trials had pooled sensitivity of 95% (95% CI 87% to 99%) and specificity of 62% (95% CI 38% to 82%), while composite tests offered the best performance characteristics.ConclusionsThere is a lack of strong evidence to support the use of extubation readiness tests in preterm infants. Although spontaneous breathing trials are attractive assessment tools, higher quality studies are needed for determining the optimal strategies for improving their accuracy.

Diffuse excessive high signal intensity on term equivalent MRI does not predict disability: a systematic review and meta-analysis

2020 ◽  
Vol 106 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Chandra Prakash Rath ◽  
Saumil Desai ◽  
Shripada C Rao ◽  
Sanjay Patole
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Roc Curve ◽  
Signal Intensity ◽  
Meta Analysis ◽  
High Signal Intensity ◽  
Cochrane Library ◽  
Mental Disability ◽  
High Signal ◽  
Operating Characteristics

ObjectiveTo evaluate whether diffuse excessive high signal intensity (DEHSI) on term equivalent age MRI (TEA-MRI) predicts disability in preterm infants.DesignThis is a systematic review and meta-analysis. Medline, EMBASE, Cochrane Library, EMCARE, Google Scholar and MedNar databases were searched in July 2019. Studies comparing developmental outcomes of isolated DEHSI on TEA-MRI versus normal TEA-MRI were included. Two reviewers independently extracted data and assessed the risk of bias. Meta-analysis was undertaken where data were available in a format suitable for pooling.Main outcome measuresNeurodevelopmental outcomes ≥1 year of corrected age based on validated tools.ResultsA total of 15 studies (n=1832) were included, of which data from 9 studies were available for meta-analysis. The pooled estimate (n=7) for sensitivity of DEHSI in predicting cognitive/mental disability was 0.58 (95% CI 0.34 to 0.79) and for specificity was 0.46 (95% CI 0.20 to 0.74). The summary area under the receiver operating characteristics (ROC) curve was low at 0.54 (CI 0.50 to 0.58). A pooled diagnostic OR (DOR) of 1 indicated that DEHSI does not discriminate preterm infants with and without mental disability. The pooled estimate (n=8) for sensitivity of DEHSI in predicting cerebral palsy (CP) was 0.57 (95% CI 0.37 to 0.75) and for specificity was 0.41 (95% CI 0.24 to 0.62). The summary area under the ROC curve was low at 0.51 (CI 0.46 to 0.55). A pooled DOR of 1 indicated that DEHSI does not discriminate between preterm infants with and without CP.ConclusionsDEHSI on TEA-MRI did not predict future development of cognitive/mental disabilities or CP.PROSPERO registration numberCRD42019130576.

scholarly journals Quality Improvement to Increase Breastfeeding in Preterm Infants: Systematic Review and Meta-Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Lingyu Fang ◽  
Lianqiang Wu ◽  
Shuping Han ◽  
Xiaohui Chen ◽  
Zhangbin Yu
Keyword(s):  
Quality Improvement ◽  
Publication Bias ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Meta Analysis ◽  
Interrupted Time Series ◽  
Primary Outcome Measure ◽  
Cochrane Library ◽  
Term Infants ◽  
Before And After

Background and Objective: Due to its numerous health benefits, breast milk (BM) is recommended for preterm infants. Despite such recommendations, the rates of breastfeeding in preterm infants are lower than that in term infants. Quality improvement (QI) bundles increase breastfeeding in preterm infants, but their replication in neonatal intensive care units has had inconsistent outcomes.Methods: We used the Population or Problem, Intervention, Comparison, and Outcomes (PICO) framework to develop our search strategy, and searched MEDLINE, Embase, and the Cochrane Library from inception through January 15, 2021. Studies describing any active QI intervention to increase BM use in preterm infants were included. The primary outcome measure was the rate of any breastfeeding or exclusive mother's own milk (MOM) at discharge or during hospitalization.Results: Sixteen studies were eligible for inclusion and showed an acceptable risk of bias, and included 1 interrupted time series, study 3 controlled before-and-after studies, and 12 uncontrolled before-and-after studies; of these, 3 studies were excluded due to insufficient dichotomous data, 13 were included in the meta-analysis. In the meta-analysis, the rate of any breastfeeding was significantly improved at discharge and during hospitalization after QI [risk ratio (RR) = 1.23, 95% confidence interval (CI): 1.14–1.32, P &lt; 0.00001 and RR = 1.89, 95% CI: 1.09–3.29, P = 0.02, respectively]. The rate of exclusive MOM after QI was also significantly increased at discharge (RR = 1.51, 95% CI: 1.04–2.18, P = 0.03), but not during hospitalization (RR = 1.53, 95% CI: 0.78–2.98, P = 0.22). However, after sensitivity analysis, the comprehensive results still suggested that QI could significantly improve the rate of exclusive MOM during hospitalization (RR = 1.21, 95% CI: 1.08–1.35, P = 0.001). Funnel plots and Egger's test indicated publication bias in the rate of any BF at discharge. We corrected publication bias by trim and fill analysis, and corrected RR to 1.272, 95% CI: (1.175, 1.369), which was consistent with the results of the initial model.Conclusions: A QI bundle appears to be effective for promoting BM use in preterm infants at discharge or during hospitalization.

scholarly journals Effect of Family-centered Care Interventions on Motor and Neurobehavior Development of Very Preterm Infants: A Protocol of Systematic Review

2020 ◽  
Author(s):  
Manasa Kolibylu Raghupathy ◽  
Bhamini Krishna Rao ◽  
Shubha R Nayak ◽  
Alicia J Spittle ◽  
Shradha S Parsekar
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Infant Development ◽  
Data Extraction ◽  
Meta Analysis ◽  
Health Concern ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Very Preterm Infants ◽  
Very Preterm

Abstract Background: Globally, preterm birth is a health concern leading to various developmental difficulties such as poor motor and/or cognitive function. For infants born preterm, FCC promotes developmental skills over the time in an appropriate enriched environment. The purpose of this study is to systematically review and assess the evidence of FCC interventions on motor and neurobehavioral development in very preterm infants. Additionally, this review aims to determine the factors that might affect the infant development.Methods: Systematic review will be carried out by including quasi-experimental controlled trials and randomized controlled trials. Electronic databases such as Scopus, PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, and PsycINFO will be searched using database specific terms. Additionally, searches will be carried out in ProQuest, and references of included studies will be searched. Two review authors, independently, will conduct the screening, data extraction, and critical appraisal of included studies. If possible, meta-analysis will be undertaken to assess the effect of FCC on motor and neurobehavior of premature infants.Conclusion: The review will provide insights regarding the effect of the FCC on preterm infants. This systematic review will guide the clinicians on the feasibility of practicing FCC that might support and promote the integration of parents into various rehabilitation settings.Systematic review registration: Protocol has been submitted to PROSPERO on July 26, 2020.

scholarly journals The clinical effectiveness and cost-effectiveness of heated humidified high-flow nasal cannula compared with usual care for preterm infants: systematic review and economic evaluation

2016 ◽  
Vol 20 (30) ◽  
pp. 1-68 ◽  
Author(s):  
Nigel Fleeman ◽  
James Mahon ◽  
Vickie Bates ◽  
Rumona Dickson ◽  
Yenal Dundar ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Usual Care ◽  
Preterm Infants ◽  
Meta Analysis ◽  
Secondary Analysis ◽  
Clinical Effectiveness ◽  
High Flow ◽  
High Flow Nasal Cannula ◽  
Primary Analysis ◽  
The Cost

BackgroundRespiratory problems are one of the most common causes of morbidity in preterm infants and may be treated with several modalities for respiratory support such as nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive-pressure ventilation. The heated humidified high-flow nasal cannula (HHHFNC) is gaining popularity in clinical practice.ObjectivesTo address the clinical effectiveness of HHHFNC compared with usual care for preterm infants we systematically reviewed the evidence of HHHFNC with usual care following ventilation (the primary analysis) and with no prior ventilation (the secondary analysis). The primary outcome was treatment failure defined as the need for reintubation (primary analysis) or intubation (secondary analysis). We also aimed to assess the cost-effectiveness of HHHFNC compared with usual care if evidence permitted.Data sourcesThe following databases were searched: MEDLINE (2000 to 12 January 2015), EMBASE (2000 to 12 January 2015), The Cochrane Library (issue 1, 2015), ISI Web of Science (2000 to 12 January 2015), PubMed (1 March 2014 to 12 January 2015) and seven trial and research registers. Bibliographies of retrieved citations were also examined.Review methodsTwo reviewers independently screened all titles and abstracts to identify potentially relevant studies for inclusion in the review. Full-text copies were assessed independently. Data were extracted and assessed for risk of bias. Summary statistics were extracted for each outcome and, when possible, data were pooled. A meta-analysis was only conducted for the primary analysis, using fixed-effects models. An economic evaluation was planned.ResultsClinical evidence was derived from seven randomised controlled trials (RCTs): four RCTs for the primary analysis and three RCTs for the secondary analysis. Meta-analysis found that only for nasal trauma leading to a change of treatment was there a statistically significant difference, favouring HHHFNC over NCPAP [risk ratio (RR) 0.21, 95% confidence interval (CI) 0.10 to 0.42]. For the following outcomes, there were no statistically significant differences between arms: treatment failure (reintubation < 7 days; RR 0.76, 95% CI 0.54 to 1.09), bronchopulmonary dysplasia (RR 0.92, 95% CI 0.72 to 1.17), death (RR 0.56, 95% CI 0.22 to 1.44), pneumothorax (RR 0.33, 95% CI 0.03 to 3.12), intraventricular haemorrhage (grade ≥ 3; RR 0.41, 95% CI 0.15 to 1.15), necrotising enterocolitis (RR 0.41, 95% CI 0.15 to 1.14), apnoea (RR 1.08, 95% CI 0.74 to 1.57) and acidosis (RR 1.16, 95% CI 0.38 to 3.58). With no evidence to support the superiority of HHHFNC over NCPAP, a cost-minimisation analysis was undertaken, the results suggesting HHHFNC to be less costly than NCPAP. However, this finding is sensitive to the lifespan of equipment and the cost differential of consumables.LimitationsThere is a lack of published RCTs of relatively large-sized populations comparing HHHFNC with usual care; this is particularly true for preterm infants who had received no prior ventilation.ConclusionsThere is a lack of convincing evidence suggesting that HHHFNC is superior or inferior to usual care, in particular NCPAP. There is also uncertainty regarding whether or not HHHFNC can be considered cost-effective. Further evidence comparing HHHFNC with usual care is required.Study registrationThis review is registered as PROSPERO CRD42015015978.FundingThe National Institute for Health Research Health Technology Assessment programme.

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.

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