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Does randomized controlled trial evidence support early administration of inhaled corticosteroids for preventing chronic lung disease in ventilated very low birth weight preterm neonates?

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  • Additional Information
    • Clinical Answer:
      Although early administration of inhaled steroids might help to reduce the composite outcome of mortality or chronic lung disease in preterm infants born at 23 to 33 weeks gestation, evidence from randomized controlled trials is insufficient to allow full assessment of their effects. Moderate‐quality evidence shows similar rates of chronic lung disease at 36 weeks postmenstrual age among infants administered inhaled steroids early (during first two weeks of life) and infants receiving placebo, and shows that, when a composite outcome was assessed, fewer infants died or had chronic lung disease at 36 weeks postmenstrual age with steroids than with placebo. Of note, these results should be taken with caution, as the upper confidence interval limit is close to one. Six randomized controlled trials (RCTs) including around 450 to 1400 participants provided no evidence that steroids were effective in reducing the incidence of chronic lung disease at 28 days of age, death at 36 weeks, subsequent requirements for systemic steroid, failure to extubate within 14 days or neurodevelopmental impairment. Rates of adverse events (such as hyperglycaemia and gastrointestinal bleeding) were similar in both groups, although one small trial reported higher rates of suppression of the pituitary‐adrenal axis after inhaled corticosteroids were administered. Most trials were underpowered to provide meaningful results. Long‐term follow‐up of the European Union‐funded international RCT on use of inhaled steroids once completed will provide further evidence on use of inhaled steroids. Lack of clinical effect of inhaled steroids may be due to various issues, such as lack of therapeutic action of inhaled steroids, suboptimal aerosol delivery and suboptimal dose.
    • Accession Number:
      10.1002/cca.1633
    • Rights:
      Copyright Cochrane Innovations and John Wiley & Sons, Ltd 2015. All rights reserved.
    • Accession Number:
      cca1633
  • Citations
    • ABNT:
      MOHAMED, A. Does randomized controlled trial evidence support early administration of inhaled corticosteroids for preventing chronic lung disease in ventilated very low birth weight preterm neonates? Cochrane Clinical Answers, [s. l.], 2017. DOI 10.1002/cca.1633. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lsdcca&AN=cca1633. Acesso em: 24 set. 2020.
    • AMA:
      Mohamed A. Does randomized controlled trial evidence support early administration of inhaled corticosteroids for preventing chronic lung disease in ventilated very low birth weight preterm neonates? Cochrane Clinical Answers. June 2017. doi:10.1002/cca.1633
    • APA:
      Mohamed, A. (2017). Does randomized controlled trial evidence support early administration of inhaled corticosteroids for preventing chronic lung disease in ventilated very low birth weight preterm neonates? Cochrane Clinical Answers. https://doi.org/10.1002/cca.1633
    • Chicago/Turabian: Author-Date:
      Mohamed, Abdel‐Latif. 2017. “Does Randomized Controlled Trial Evidence Support Early Administration of Inhaled Corticosteroids for Preventing Chronic Lung Disease in Ventilated Very Low Birth Weight Preterm Neonates?” Cochrane Clinical Answers, June. doi:10.1002/cca.1633.
    • Harvard:
      Mohamed, A. (2017) ‘Does randomized controlled trial evidence support early administration of inhaled corticosteroids for preventing chronic lung disease in ventilated very low birth weight preterm neonates?’, Cochrane Clinical Answers. doi: 10.1002/cca.1633.
    • Harvard: Australian:
      Mohamed, A 2017, ‘Does randomized controlled trial evidence support early administration of inhaled corticosteroids for preventing chronic lung disease in ventilated very low birth weight preterm neonates?’, Cochrane Clinical Answers, viewed 24 September 2020, .
    • MLA:
      Mohamed, Abdel‐Latif. “Does Randomized Controlled Trial Evidence Support Early Administration of Inhaled Corticosteroids for Preventing Chronic Lung Disease in Ventilated Very Low Birth Weight Preterm Neonates?” Cochrane Clinical Answers, June 2017. EBSCOhost, doi:10.1002/cca.1633.
    • Chicago/Turabian: Humanities:
      Mohamed, Abdel‐Latif. “Does Randomized Controlled Trial Evidence Support Early Administration of Inhaled Corticosteroids for Preventing Chronic Lung Disease in Ventilated Very Low Birth Weight Preterm Neonates?” Cochrane Clinical Answers, June 1, 2017. doi:10.1002/cca.1633.
    • Vancouver/ICMJE:
      Mohamed A. Does randomized controlled trial evidence support early administration of inhaled corticosteroids for preventing chronic lung disease in ventilated very low birth weight preterm neonates? Cochrane Clinical Answers [Internet]. 2017 Jun 1 [cited 2020 Sep 24]; Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lsdcca&AN=cca1633