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

Jianguo Zhou; Zhuowen Yu; Chao Chen

doi:10.1055/s-0039-3400984

American Journal of Perinatology, Table of Contents

Am J Perinatol 2021; 38(07): 662-668
DOI: 10.1055/s-0039-3400984

Review Article

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

Jianguo Zhou

¹Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China

,

Zhuowen Yu

²Department of Gastroenterology and Pulmonary Disease, Children's Hospital of Fudan University, Shanghai, China

,

Chao Chen

¹Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China

› Author Affiliations

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.

Results 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.

Keywords

hydrocortisone - bronchopulmonary dysplasia - mortality - meta-analysis

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References

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