Clinical and Laboratory ObservationsAn Update on the Impact of Postnatal Systemic Corticosteroids on Mortality and Cerebral Palsy in Preterm Infants: Effect Modification by Risk of Bronchopulmonary Dysplasia
Section snippets
Methods
We used the methods of the Cochrane Neonatal Review Group to identify RCTs of systemic postnatal CS that had reported data on BPD (defined as oxygen dependency at 36 weeks' postmenstrual age), mortality to the latest reported age, and rates of CP.3, 4 Some data were published in full and some were obtained by personal communication with the lead authors of the RCTs.
The relationship between the risk difference (RD) for the combined outcome, death or CP, on the y-axis and the rate of BPD in the
Results
Twenty RCTs had the appropriate data required, comprising the 14 RCTs included in the first meta-regression,6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28 and an additional 6 RCTs (Table).29, 30, 31, 32, 33, 34, 35, 36, 37 The negative relationship between RD for death or CP against the rate of BPD in the control group we had identified previously persisted in the new analysis with all 20 RCTs included (Figure; P = .003). The regression line cut the
Discussion
The negative relationship between the risk of death or CP and the rate of BPD in the control group previously described is basically unchanged with the addition of data from more RCTs and with the updating of data from some of the previously included RCTs. If anything, the CIs are slightly narrower and the statistical significance slightly greater in the updated analysis.
Clinicians who need guidance as to whether to start systemic CS in ventilator-dependent infants could use prediction
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Cited by (0)
Supported by the National Health and Medical Research Council (NHMRC) of Australia (108700, 606789, and Centre of Research Excellence 1060733) and the Victorian Government's Operational Infrastructure Support Program. P.D. is supported in part by a Practitioner Fellowship (grant 1059111) from the National Health and Medical Research Council. The authors declare no conflicts of interest.
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Deceased.