Long-term effects of postnatal dexamethasone administration in prevention or treatment of chronic lung disease in preterm infants: a Meta-analysis
10.3760/cma.j.issn.1671-7368.2013.08.012
- VernacularTitle:地塞米松治疗或预防早产儿慢性肺疾病远期预后的Meta分析
- Author:
Meiying QUAN
;
Zhenghong LI
- Publication Type:Journal Article
- Keywords:
Dexamethasone;
Infant,premature;
Lung diseases
- From:
Chinese Journal of General Practitioners
2013;12(8):616-621
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the long-term effects of postnatal dexamethasone administration in prevention or treatment of chronic lung disease (CLD) in preterm infants.Methods All randomized controlled clinical trials (RCT) on long-term effect of postnatal dexamethasone in prevention or treatment of chronic lung disease in preterm infants were searched in Medline,Embase database,Cochrane Library and Chinese Medical Citation Index database,China National Knowledge infrastructure,VIP Chinese Periodical Database and Chinese Digital Hospital Library and Wanfang Chinese periodical database.As a supplementation,the works of domestic and international pediatric conferences were collected by manual search.The follow-up time was defined as longer than two years.Revman 5.0 was used for Meta-analysis for the effects of dexamethasone on nervous system,respiratory system and mortality.Results Eight RCTs fulfilled the including criteria.Statistical analysis revealed that the incidence of recurrent respiratory disease decreased from 49.7％ to 38.9％ in the dexamethasone group compared to the control group with RR =0.57 (95％ CI:0.37-0.88,P ＜ 0.05).But the incidence of cerebral palsy in dexamethasone group increased significantly (RR =1.95,95％ CI:1.41-2.71,P ＜ 0.01).Stratified analysis revealed that the incidence of cerebral palsy in early-use group (within 1 week after birth) was higher than that in control group (RR =2.59,95％ CI:1.59-4.21,P ＜0.01) ; while the incidence in later-use group (1 week after birth) was not statistically different from that in control group (RR =1.5,95％ CI:0.95-2.36,P =0.08).There were no significant differences in the incidence of mental retardation (RR =0.77,95％ CI:0.28-0.14,P ＞ 0.05),deafness (RR =0.52,95％ CI:0.17-1.56,P =0.24) and severe visual impairment (RR =1.56,95％ CI:0.77-3.18,P =0.22) between dexamethasone group and control group,as well as in mortality rate (RR =0.91,95％ CI:0.71-1.16,P ＞ 0.05).Conclusions Intravenous administration of dexamethasone after birth for prevention or treatment of CLD in preterm infants can reduce the incidence of recurrent respiratory diseases in childhood; meanwhile the incidence of cerebral palsy may increase,it almost occurs in the early dexamethason administration group,not in the late group.Dexamethasone may not reduce the mortality of CLD.
