Airway Administration of Budesonide Combined With Pulmonary Surfactant to Prevent Bronchopulmonary Dysplasia in Preterm Infants: A Systematic Review and Meta‐Analysis

ABSTRACT Objective To evaluate the effectiveness and safety of using budesonide in combination with pulmonary surfactant compared with the pulmonary surfactant alone in preventing bronchopulmonary dysplasia in preterm infants. Design Four databases (EMBASE, MEDLINE, Web of science, and Cochrane Central) were searched for randomized controlled trials comparing the use of intratracheal budesonide in combination with pulmonary surfactant to the use of pulmonary surfactant alone. Review manager 5.3 and Stata 17 software were used for statistical analysis. Main Outcomes Measures The primary outcome was the incidence of bronchopulmonary dysplasia in the group treated with budesonide combined with pulmonary surfactant, compared to the group treated with pulmonary surfactant alone. Secondary outcomes contained mortality rate, repeated use of pulmonary surfactant, length of hospital stay, and complications. Results 12 randomized controlled studies were included in this meta‐analysis, including 2428 preterm infants. Compared to the use of pulmonary surfactant alone, the combination of budesonide and pulmonary surfactant can significantly reduce the incidence of bronchopulmonary dysplasia ( p < 0.01, RR = 0.66, 95% CI: 0.53–0.84, low quality of evidence). Even after adjusting for the impact of publication bias, the results still indicate that the combination of budesonide and pulmonary surfactant significantly lowers the risk of BPD (RR = 0.77, 95% CI: 0.63–0.93). Additionally, it significantly decreases in‐hospital mortality rates in premature infants ( p = 0.02, RR = 0.80, 95% CI: 0.67–0.96, moderate quality of evidence), the incidence of pulmonary hemorrhage ( p < 0.01, RR = 0.61, 95% CI: 0.43–0.85, moderate quality of evidence), and the need of repeated use of pulmonary surfactant ( p < 0.01, RR = 0.52, 95% CI: 0.44–0.62, high quality of evidence). No statistically significant differences were observed in related complications. Conclusion Compared to the use of pulmonary surfactant alone, the combination of budesonide and pulmonary surfactant may prevent bronchopulmonary dysplasia in preterm infants, and does not increase the occurrence of related complications.