Efficacy of intratracheal budesonide plus surfactant vs. Surfactant alone on bronchopulmonary dysplasia in preterm Infants: A meta-analysis of randomized controlled trials

Abstract

Background Bronchopulmonary dysplasia (BPD) is a chronic pulmonary disease commonly affecting preterm infants. The potential benefits of combining budesonide with surfactant for preterms with early BPD remain uncertain and warrant further exploration. Objective We conducted a systematic review and meta -analysis of randomized controlled trials (RCTs) to evaluate the efficacy of intratracheal budesonide plus surfactant compared with surfactant alone in preterm infants. Methods We searched PubMed, Embase and Cochrane Central databases from inception to November 2024. We conducted a meta -analysis following the PRISMA guidelines. We calculated the risk ratios (RRs) of endpoints of interest with 95% confidence intervals using a random effects model. R software (version 4.3.2) was used for statistical analyses. Heterogeneity was assessed with I2 statistics. Results Eight RCTs including 2029 preterm infants were included. Compared with surfactant alone, a combined intratracheal budesonide plus surfactant significantly reduced the risk of bronchopulmonary dysplasia (RR: 0.70; 95 % CI: 0.54–0.91; p = 0.007; I2 = 71.4 %), mortality (RR: 0.81; 95 % CI: 0.66–0.98; p = 0.029; I2 = 14.6 %), pulmonary hemorrhage (RR: 0.58; 95 % CI: 0.37–0.90; p = 0.015; I2 = 0 %) and patent ductus arteriosus (RR: 0.84; 95 % CI: 0.75–0.94; p = 0.004; I2 = 0 %). Conclusion This meta -analysis found that intratracheal budesonide plus surfactant reduces the risk of bronchopulmonary dysplasia, mortality, pulmonary hemorrhage and patent ductus arteriosus compared with surfactant alone. Given its potential to reduce pulmonary complications associated with prematurity, clinicians may consider this combination therapy.