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

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.

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Tumour necrosis factor (-308A) polymorphism in very preterm infants with bronchopulmonary dysplasia: a meta-analysis

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/adc.2008.153122 ◽

2008 ◽

Vol 94 (4) ◽

pp. F257-F259 ◽

Cited By ~ 13

Author(s):

M Chauhan ◽

S Bombell ◽

W McGuire

Keyword(s):

Tumour Necrosis Factor ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Tumour Necrosis ◽

Meta Analysis ◽

Very Preterm Infants ◽

Very Preterm ◽

Necrosis Factor

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Donor Human Milk Protects against Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis

10.20944/preprints201801.0107.v1 ◽

2018 ◽

Author(s):

Eduardo Villamor-Martínez ◽

Maria Pierro ◽

Giacomo Cavallaro ◽

Fabio Mosca ◽

Boris W. Kramer ◽

...

Keyword(s):

Systematic Review ◽

Human Milk ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Observational Studies ◽

Meta Analysis ◽

Very Preterm Infants ◽

Very Preterm ◽

Donor Human Milk ◽

Preterm Formula

Bronchopulmonary dysplasia (BPD) is the most common complication after preterm birth. Pasteurized donor human milk (DHM) has increasingly become the standard of care for very preterm infants over the use of preterm formula (PF) if mother’s own milk (MOM) is unavailable. Studies have reported beneficial effects of DHM on BPD. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies on the effects of DHM on BPD and other respiratory outcomes. Eighteen studies met the inclusion criteria. Meta-analysis of RCT’s could not demonstrate that supplementation of MOM with DHM reduced BPD when compared to PF (3 studies, risk ratio [RR] 0.89, 95% confidence interval [CI] 0.60–1.32). However, meta-analysis of observational studies showed that DHM supplementation reduced BPD (8 studies, RR 0.78, 95% CI 0.67–0.90). An exclusive human milk diet reduced the risk of BPD, compared to a diet with PF and/or bovine milk-based fortifier (3 studies, RR 0.80, 95% CI 0.68–0.95). Feeding raw MOM, compared to feeding pasteurized MOM, protected against BPD (2 studies, RR 0.77, 95% CI 0.62–0.96). In conclusion, our data suggest that DHM protects against BPD in very preterm infants, but pasteurization of human milk reduces the benefit.

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Effect of Hydrocortisone Therapy Initiated 7 to 14 Days After Birth on Mortality or Bronchopulmonary Dysplasia Among Very Preterm Infants Receiving Mechanical Ventilation

JAMA ◽

10.1001/jama.2018.21443 ◽

2019 ◽

Vol 321 (4) ◽

pp. 354 ◽

Cited By ~ 18

Author(s):

Wes Onland ◽

Filip Cools ◽

Andre Kroon ◽

Karin Rademaker ◽

Maruschka P. Merkus ◽

...

Keyword(s):

Mechanical Ventilation ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Very Preterm Infants ◽

Very Preterm

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Neighborhood Disadvantage and Early Respiratory Outcomes in Very Preterm Infants with Bronchopulmonary Dysplasia.

The Journal of Pediatrics ◽

10.1016/j.jpeds.2021.06.061 ◽

2021 ◽

Author(s):

Juliette Deschamps ◽

Mohamed Boucekine ◽

Laurence Fayol ◽

Jean Christophe Dubus ◽

Steve Nauleau ◽

...

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Neighborhood Disadvantage ◽

Very Preterm Infants ◽

Very Preterm ◽

Respiratory Outcomes

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Severity of Bronchopulmonary Dysplasia Among Very Preterm Infants in the United States

PEDIATRICS ◽

10.1542/peds.2020-030007 ◽

2021 ◽

pp. e2020030007

Author(s):

Erik A. Jensen ◽

Erika M. Edwards ◽

Lucy T. Greenberg ◽

Roger F. Soll ◽

Danielle E.Y. Ehret ◽

...

Keyword(s):

United States ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

The United States ◽

Very Preterm Infants ◽

Very Preterm

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Lung Ultrasound in Bronchopulmonary Dysplasia: Patterns and Predictors in Very Preterm Infants

Neonatology ◽

10.1159/000517585 ◽

2021 ◽

pp. 1-9

Author(s):

Victoria Aldecoa-Bilbao ◽

Mar Velilla ◽

Marta Teresa-Palacio ◽

Carla Balcells Esponera ◽

Ana Herranz Barbero ◽

...

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Lung Ultrasound ◽

Respiratory Support ◽

Very Preterm Infants ◽

Very Preterm ◽

Pleural Line ◽

Respiratory Management ◽

Postmenstrual Age ◽

Severity Of The Disease

Introduction: Lung ultrasound (LUS) is useful for respiratory management in very preterm infants (VPI), but little is known about the echographic patterns in bronchopulmonary dysplasia (BPD), the relation between the image findings, and the severity of the disease and its long-term outcomes. We aimed to describe LUS patterns in BPD and analyze the accuracy of LUS to predict the need for respiratory support at 36 weeks postmenstrual age (PMA) in VPI. Methods: Preterm infants ≤30.6 weeks of gestational age were recruited. LUS was performed at admission, at 7th, and 28th day of life (DOL) with a standardized protocol (6 zones: anterior, lateral, and posterior fields). Clinical data, respiratory outcomes, and image findings were recorded. Results: Eighty-nine patients were studied. Infants with BPD had significantly higher LUS score at admission, at 7th, and 28th DOL. Patients with BPD exhibited more consolidations and pleural line abnormalities at 7th and 28th DOL than those without BPD (p < 0.001), regardless of the definition used for BPD. LUS at 7th DOL predicted NICHD 2001-BPD with R2 = 0.522; AUC = 0.87 (0.79–0.94), p < 0.001, and Jensen 2019-BPD with R2 = 0.315 (AUC = 0.80 [0.70–0.90], p < 0.001). A model including mechanical ventilation >5 days, oxygen therapy for 7 days and LUS score at 7th DOL accurately predicted the need for respiratory support at 36 weeks PMA (R2 = 0.655, p < 0.001) with an AUC = 0.90 (0.84–0.97), p < 0.001. Conclusion: LUS score, pleural line abnormalities, and consolidations can be useful to diagnose BPD in VPI and to predict its severity after the first week of life.

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Response to bronchodilators in very preterm infants with evolving bronchopulmonary dysplasia

Research and Reports in Neonatology ◽

10.2147/rrn.s96961 ◽

2015 ◽

pp. 113 ◽

Cited By ~ 2

Author(s):

Daniel K Morrow ◽

Diane Schilling ◽

Cynthia McEvoy

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Very Preterm Infants ◽

Very Preterm

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Bronchopulmonary dysplasia in very preterm infants: Outcome up to preschool age, in a single center of Austria

Pediatrics International ◽

10.1111/ped.13815 ◽

2019 ◽

Vol 61 (4) ◽

pp. 381-387 ◽

Cited By ~ 3

Author(s):

Friedrich Reiterer ◽

Anna Scheuchenegger ◽

Bernhard Resch ◽

Ute Maurer‐Fellbaum ◽

Alexander Avian ◽

...

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Preschool Age ◽

Single Center ◽

Very Preterm Infants ◽

Very Preterm

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

American Journal of Perinatology ◽

10.1055/s-0039-3400984 ◽

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.

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