A systematic review and meta-analysis of pulmonary surfactant combined with budesonide in the treatment of neonatal respiratory distress syndrome

Zongyan Yi; Yajuan Tan; Yang Liu; Ling Jiang; Li Luo; Liang Wang; Wei Lei; Jiping Tan; Ruofen Yan

doi:10.21037/tp-22-8

A systematic review and meta-analysis of pulmonary surfactant combined with budesonide in the treatment of neonatal respiratory distress syndrome

Transl Pediatr. 2022 Apr;11(4):526-536. doi: 10.21037/tp-22-8.

Authors

Zongyan Yi¹, Yajuan Tan¹, Yang Liu¹, Ling Jiang¹, Li Luo¹, Liang Wang¹, Wei Lei², Jiping Tan², Ruofen Yan²

Affiliations

¹ Department of Pediatrics, The Ethnic Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China.
² Department of Nursing, The Ethnic Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China.

Abstract

Background: Neonatal respiratory distress syndrome (NRDS), if caused by a lack of pulmonary surfactant (PS), leads to progressive alveolar collapse. Glucocorticoids have anti-inflammatory and anti-allergic effects and can reduce bronchial and pulmonary edema. This research hopes to systematically evaluate the efficacy and safety of animal-derived PS combined with the glucocorticoid drug budesonide in the treatment of NRDS.

Methods: Electronic databases (i.e., Wanfang, Weipu, CNKI, PubMed, Embase, Cochrane Library) were searched from inception until May 30th, 2021. Studies relevant to the treatment of pulmonary surfactant combined with budesonide in the treatment of neonatal respiratory distress syndrome were identified. Consequently, all the studies that met the inclusion criteria were considered qualified for screening. For the meta-analysis, all data were analyzed using RevMan 5.3 software. Furthermore, subgroup analysis was performed to evaluate the administration method of budesonide (nebulized inhalation, intratracheal instillation) combined with intratracheal instillation of pulmonary surfactant.

Results: A total of 10 articles were included in this study, involving 527 children. This meta-analysis suggests that the treatment of intratracheal infusion of pulmonary surfactant combined with budesonide therapy can effectively (I) reduce the time of mechanical ventilation (OR =-1.72,95% CI: -2.44 to -1.01, P<0.00001); (II) reduce the length of stay (OR =-5.17, 95% CI: -9.35 to -0.99, P=0.02); (III) reduce the incidence of bronchopulmonary dysplasia (BPD) (OR =0.52, 95% CI: 0.39-0.68, P<0.00001); and (IV) reduce the incidence of BPD (RR =0.73, 95% CI: 0.40-1.35, P=0.32). There was no significant difference in the incidence of retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA), or sepsis between the experimental group and the control group.

Discussion: The treatment of animal-derived pulmonary surfactant combined with budesonide can effectively shorten the hospital stay and reduce the time of invasive mechanical ventilation and the incidence of BPD. Meanwhile, it does not increase the risk of related complications or death. This approach can be applied clinically.

Keywords: Pulmonary surfactant; budesonide; meta-analysis; neonatal respiratory distress syndrome (NRDS).