Faculty Opinions recommendation of Association of Noninvasive Ventilation Strategies With Mortality and Bronchopulmonary Dysplasia Among Preterm Infants: A Systematic Review and Meta-analysis.

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.

Download Full-text

Delivery room interventions to prevent bronchopulmonary dysplasia in preterm infants: a protocol for a systematic review and network meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-028066 ◽

2019 ◽

Vol 9 (8) ◽

pp. e028066 ◽

Cited By ~ 3

Author(s):

Souvik Mitra ◽

Timothy Disher ◽

Gerhard Pichler ◽

Brandon D'Souza ◽

Helen Mccord ◽

...

Keyword(s):

Systematic Review ◽

Lung Injury ◽

Bayesian Network ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Systematic Reviews ◽

Meta Analysis ◽

Delivery Room ◽

Controlled Trials ◽

Evidence Based

IntroductionAs gestational age decreases, incidence of bronchopulmonary dysplasia (BPD) and chronic lung disease increases. There are many interventions used in the delivery room to prevent acute lung injury and consequently BPD in these patients. The availability of different treatment options often poses a practical challenge to the practicing neonatologist when it comes to making an evidence-based choice as the multitude of pairwise systematic reviews including Cochrane reviews that are currently available only provide a narrow perspective through head-to-head comparisons.Methods and analysisWe will conduct a systematic review of all randomised controlled trials evaluating delivery room interventions within the first golden hour after birth for prevention of BPD. The primary outcome includes BPD. Secondary outcomes include death at 36 weeks of postmenstrual age or before discharge; severe intraventricular haemorrhage (grade 3 or 4 based on the Papile criteria); any air leak syndromes (including pneumothorax or pulmonary interstitial emphysema); retinopathy of prematurity (any stage) and neurodevelopmental impairment at 18–24 months. We will search from their inception to August 2018, the following databases: Medline, EMBASE and Cochrane Central Register of Controlled Trials as well as grey literature resources. Two reviewers will independently screen titles and abstracts, review full texts, extract information and assess the risk of bias and the confidence in the estimate (with Grading of Recommendations Assessment, Development and Evaluation approach). This review will use Bayesian network meta-analysis approach which allows the comparison of the multiple delivery room interventions for prevention of BPD. We will perform a Bayesian network meta-analysis to combine the pooled direct and indirect treatment effect estimates for each outcome, effectiveness and safety of delivery room interventions for prevention of BPD.Ethics and disseminationThe proposed protocol is a network meta-analysis, which has been registered on PROSPERO International prospective register of systematic reviews (CRD42018078648). The results will provide an evidence-based guide to choosing the right sequence of early postnatal interventions that will be associated with the least likelihood of inducing lung injury and BPD in preterm infants. Furthermore, we will identify knowledge gaps and will encourage further research for other therapeutic options. Therefore, its results will be disseminated through peer-reviewed publications and conference presentations. Due to the nature of the design, no ethics approval is necessary.

Download Full-text

Faculty Opinions recommendation of Optimizing Caffeine Use and Risk of Bronchopulmonary Dysplasia in Preterm Infants: A Systematic Review, Meta-analysis, and Application of Grading of Recommendations Assessment, Development, and Evaluation Methodology.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733236813.793576197 ◽

2020 ◽

Author(s):

Vineet Bhandari

Keyword(s):

Systematic Review ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Meta Analysis ◽

Evaluation Methodology ◽

Assessment Development

Download Full-text

Safety and Effectiveness of Human Stem Cells for Bronchopulmonary Dysplasia in Preterm Infants: A Systematic Review and Meta-analysis

10.22541/au.160439960.05365935/v1 ◽

2020 ◽

Author(s):

Jing Zhang ◽

Yuehua Guo ◽

Haiyan Xu ◽

Kai Mu

Keyword(s):

Systematic Review ◽

Stem Cells ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Meta Analysis ◽

Human Stem Cells

Download Full-text

Sildenafil for bronchopulmonary dysplasia and pulmonary hypertension: a meta-analysis

Pulmonary Circulation ◽

10.1177/2045894019837875 ◽

2019 ◽

Vol 9 (3) ◽

pp. 204589401983787 ◽

Cited By ~ 6

Author(s):

Marisa van der Graaf ◽

Leonne Arindah Rojer ◽

Willem Arnold Helbing ◽

Irwin Karl Marcel Reiss ◽

Jonathan Richard Gregory Etnel ◽

...

Keyword(s):

Systematic Review ◽

Pulmonary Hypertension ◽

Adverse Events ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Complex Disease ◽

Meta Analysis ◽

Expression Patterns ◽

Serious Adverse Events ◽

Variable Expression

Bronchopulmonary dysplasia (BPD) is the most common complication in preterm infants and often complicated by pulmonary hypertension (PH), leading to substantial morbidity and mortality. Sildenafil is often used to treat PH and improve symptoms in this condition, even though evidence of safety and effectiveness is scarce. The aim of this study was to perform a systematic review and meta-analysis about the effectiveness and safety of chronic use of sildenafil in preterm infants with BPD-associated PH. Data sources were PubMed, EMBASE, and Medline. Studies reporting the effectiveness of sildenafil therapy in BPD-associated PH in newborns and infants were included. All-cause mortality, improvement in PH, improvement in respiratory scores, and adverse events were extracted. Five studies were included, yielding a total of 101 patients with 94.2 patient-years of total follow-up. The pooled mortality rate was 29.7%/year (95% confidence interval [CI] = 6.8–52.7). Estimated pulmonary arterial pressure improved > 20% in 69.3% (95% CI = 56.8–81.8) of patients within 1–6 months. Respiratory scores improved in 15.0% (95% CI = 0.0–30.4) of patients within 2–7 days. There were no serious adverse events during sildenafil therapy. This systematic review shows that in the treatment of BPD-associated PH in preterm infants, sildenafil may be associated with improvement in PAP and respiratory scores. However, there is no clear evidence of its effect on mortality rates. Considering BPD as a complex disease with variable expression patterns, these results support the need for a prospective registry and standardized approach.

Download Full-text