Meta-analysis of dexamethasone therapy started in the first 15 days of life for prevention of chronic lung disease in premature infants

We performed a systematic review of randomized controlled trials to determi ne whether the use of dexamethasone therapy in the first 15 days of life is beneficial for prevention of chronic lung disease in prematurely born infa nts, Studies were identified by conducting a literature search using the Me dline database (1970-1997) and supplemented by a search of the Cochrane Lib rary (1998, issue 4), Inclusion criteria were: 1) prospective randomized de sign with initiation of dexamethasone therapy within the first 15 days of l ife; 2) report of outcome of interest; and 3) less than 20% cross-over betw een treatment and control group during the study period. Our primary outcom es were mortality at hospital discharge and the development of chronic lung disease at 28 days of life and 36 weeks postconceptional age. The secondar y outcomes were the presence of a patent ductus arteriosus and treatment si de effects. The overall baseline event rate in the control group and pooled risk ratio (RR) of event reduction with 95% confidence interval (CI) were calculated. With dexamethasone therapy, chronic lung disease was decreased by 26% at 28 days (RR, 0.74; 95% CI, 0.57-0.96) and 48% at 36 weeks postconceptional ag e (RR, 0.52; 95% CI, 0.33-0.81). These reductions were more significant whe n dexamethasone was started in the first 72 h of life. The relative risk re duction of 24% in deaths was marginally significant (RR, 0.76; 95% CI, 0.56 -1.04), The 27% decrease in patent ductus arteriosus and 11% increase in in jection were not statistically significant, nor were any other changes. We conclude from this meta-analysis that systemic dexamethasone given to at -risk infants soon after birth may have a beneficial effect in reducing the incidence of chronic lung disease. We did not find evidence of significant short-term adverse side effects. New studies are needed to clarify long-te rm outcomes in prematurely born infants treated with dexamethasone. (C) 199 9 Wiley-Liss, Inc.