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Cochrane Database of Systematic Reviews

Late (≥ 7 days) inhalation corticosteroids to reduce bronchopulmonary dysplasia in preterm infants

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DOI:
https://doi.org/10.1002/14651858.CD002311.pub4Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 24 agosto 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Neonatología

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Wes Onland

    Correspondencia a: Department of Neonatology, Emma Children's Hospital AMC, University of Amsterdam, Amsterdam, Netherlands

    [email protected]

  • Martin Offringa

    Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada

  • Anton van Kaam

    Department of Neonatology, Emma Children's Hospital AMC, University of Amsterdam, Amsterdam, Netherlands

Contributions of authors

Dr Onland and Dr van Kaam have full access to all of the data in the review and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Study concept and design: Onland, van Kaam

  • Acquisition of data: Onland, van Kaam

  • Analysis and interpretation of data: Onland, Offringa, van Kaam

  • Drafting of the manuscript: Onland, van Kaam

  • Critical revision of the manuscript for important intellectual content: Onland, Offringa, van Kaam

  • Stastical analysis: Onland

  • Study supervision: Offringa, van Kaam

Sources of support

Internal sources

  • Department of Neonatology, AMC, Amsterdam, Netherlands.

  • Department of Pediatric Clinical Epidemiology, AMC, Netherlands.

External sources

  • Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services, USA.

    Editorial support of the Cochrane Neonatal Review Group has been funded with Federal funds from the Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services, USA, under Contract No. HHSN275201600005C.

Declarations of interest

Wes Onland: No financial disclosure to be declared. No potential conflicts of interest known.
Martin Offringa: No financial disclosure to be declared. No potential conflicts of interest known.
Anton van Kaam: No financial disclosure to be declared. No potential conflicts of interest known.

Acknowledgements

Dr P Lister, Dr R Iles, Dr B Shaw, Dr F Ducharme for writing the previous version of this review, 'Inhaled steroids for neonatal chronic lung disease'.

Dr DSchwartz, Dr T Giep, Prof M Silverman, and Dr S Brudno provided additional information for the previous version of this review.

Prof Silverman and Dr Jonsson provided precious additional data for this updated version of the review.

Ms D Haughton, Ms Y Montagne, Ms C Ovelman, Ms J Spano, and Prof R Soll of Cochrane Neonatal.

Version history

Published

Title

Stage

Authors

Version

2022 Dec 15

Late (≥ 7 days) inhaled corticosteroids to reduce bronchopulmonary dysplasia in preterm infants

Review

Wes Onland, Martin Offringa, Anton Kaam

https://doi.org/10.1002/14651858.CD002311.pub5

2017 Aug 24

Late (≥ 7 days) inhalation corticosteroids to reduce bronchopulmonary dysplasia in preterm infants

Review

Wes Onland, Martin Offringa, Anton van Kaam

https://doi.org/10.1002/14651858.CD002311.pub4

2012 Apr 18

Late (≥ 7 days) inhalation corticosteroids to reduce bronchopulmonary dysplasia in preterm infants

Review

Wes Onland, Martin Offringa, Anton van Kaam

https://doi.org/10.1002/14651858.CD002311.pub3

2010 Jan 20

Inhaled steroids for neonatal chronic lung disease

Review

Paula Lister, Richard Iles, Ben NJ Shaw, Francine M Ducharme

https://doi.org/10.1002/14651858.CD002311.pub2

1999 Oct 25

Inhaled steroids for neonatal chronic lung disease

Review

Paula Lister, Richard Iles, Ben NJ Shaw, Francine Ducharme

https://doi.org/10.1002/14651858.CD002311

Differences between protocol and review

Given the paucity of data, we failed to perform the sensitivity analyses examining the potential influence of treatment variation (type and dose of inhalation corticosteroid, duration of treatment, and delivery system).

Notes

Editorial responsibility for the review 'Inhaled steroids for neonatal chronic lung disease' has been transferred to the Cochrane Neonatal Review Group from the Cochrane Airways Group.

A new team of review authors has been assigned: Dr Wes Onland, Dr Martin Offringa, and Dr Anton Van Kaam.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Flow of inclusion of randomised controlled trials in different phases of search.
Figuras y tablas -
Figure 1

Flow of inclusion of randomised controlled trials in different phases of search.

Study flow diagram: review update.
Figuras y tablas -
Figure 2

Study flow diagram: review update.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 4

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 1 Combined outcome mortality or bronchopulmonary dysplasia at 36 weeks PMA.
Figuras y tablas -
Analysis 1.1

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 1 Combined outcome mortality or bronchopulmonary dysplasia at 36 weeks PMA.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 2 Mortality at 28 days PNA.
Figuras y tablas -
Analysis 1.2

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 2 Mortality at 28 days PNA.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 3 Mortality at 36 weeks PMA.
Figuras y tablas -
Analysis 1.3

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 3 Mortality at 36 weeks PMA.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 4 Mortality at hospital discharge.
Figuras y tablas -
Analysis 1.4

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 4 Mortality at hospital discharge.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 5 Bronchopulmonary dysplasia at 28 days PNA.
Figuras y tablas -
Analysis 1.5

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 5 Bronchopulmonary dysplasia at 28 days PNA.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 6 Bronchopulmonary dysplasia at 36 weeks PMA.
Figuras y tablas -
Analysis 1.6

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 6 Bronchopulmonary dysplasia at 36 weeks PMA.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 7 Combined outcome mortality and bronchopulmonary dysplasia at 28 days PNA.
Figuras y tablas -
Analysis 1.7

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 7 Combined outcome mortality and bronchopulmonary dysplasia at 28 days PNA.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 8 Failure to extubate day 7.
Figuras y tablas -
Analysis 1.8

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 8 Failure to extubate day 7.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 9 Failure to extubate day 14.
Figuras y tablas -
Analysis 1.9

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 9 Failure to extubate day 14.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 10 Failure to extubate at the latest reported moment.
Figuras y tablas -
Analysis 1.10

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 10 Failure to extubate at the latest reported moment.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 11 Days of mechanical ventilation.
Figuras y tablas -
Analysis 1.11

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 11 Days of mechanical ventilation.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 12 Days of supplemental oxygen.
Figuras y tablas -
Analysis 1.12

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 12 Days of supplemental oxygen.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 13 Open‐label intravenous corticosteroids.
Figuras y tablas -
Analysis 1.13

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 13 Open‐label intravenous corticosteroids.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 14 Sepsis (clinical suspected or culture proven).
Figuras y tablas -
Analysis 1.14

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 14 Sepsis (clinical suspected or culture proven).

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 15 Patent ductus arteriosus.
Figuras y tablas -
Analysis 1.15

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 15 Patent ductus arteriosus.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 16 Hypertension (> 2 SD).
Figuras y tablas -
Analysis 1.16

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 16 Hypertension (> 2 SD).

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 17 Necrotising enterocolitis.
Figuras y tablas -
Analysis 1.17

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 17 Necrotising enterocolitis.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 18 Intraventricular haemorrhage (any grade).
Figuras y tablas -
Analysis 1.18

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 18 Intraventricular haemorrhage (any grade).

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 19 Days of hospitalisation.
Figuras y tablas -
Analysis 1.19

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 19 Days of hospitalisation.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 20 Airway resistance.
Figuras y tablas -
Analysis 1.20

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 20 Airway resistance.

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 21 Dynamic lung compliance.
Figuras y tablas -
Analysis 1.21

Comparison 1 Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants, Outcome 21 Dynamic lung compliance.

Summary of findings for the main comparison. Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants

Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants

Patient or population: preterm infants
Setting: neonatal intensive care units
Intervention: inhaled corticosteroids
Comparison: placebo

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with placebo

Risk with inhaled corticosteroids

Combined outcome mortality or bronchopulmonary dysplasia at 36 weeks postmenstrual age

Study population

RR 1.10
(0.74 to 1.63)

30
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1 2 3 4 5

533 per 1000

587 per 1000
(395 to 869)

Mortality at 36 weeks postmenstrual age

Study population

RR 3.00
(0.35 to 25.78)

61
(3 RCTs)

⊕⊕⊝⊝
LOW 1 2 5 6 7

0 per 1000

0 per 1000
(0 to 0)

Bronchopulmonary dysplasia at 36 weeks postmenstrual age

Study population

RR 1.00
(0.59 to 1.70)

30
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1 2 3 4 5

600 per 1000

600 per 1000
(354 to 1000)

Open‐label intravenous corticosteroids

Study population

RR 0.51
(0.26 to 1.00)

74
(4 RCTs)

⊕⊝⊝⊝
VERY LOW 1 5 8 9 10

432 per 1000

320 per 1000
(216 to 476)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low quality: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

1Risk of bias: No serious limitations. No downgrade.
2Indirectness: Head‐to‐head comparison. No downgrade.
3Publication bias: Only one trial was able to provide data for this outcome for ventilated and non‐ventilated infants separately. Downgraded one level.
4Inconsistency: Difference in effect estimates might be explained by inclusion of both ventilated and non‐ventilated infants. Downgraded one level.
5Imprecision: Total number of included infants less than optimal information size calculation. Downgraded one level.
6Inconsistency: No inconsistency detected. No downgrade.
7Publication bias: Only two of the eight included studies reported this outcome. Downgraded one level.
8Inconsistency: Included trials investigated different inhalation drugs. Downgraded one level.
9Indirectness: No serious limitations. No downgrade.
10Publication bias: Funnel plot is asymmetrical. Downgraded one level.

Figuras y tablas -
Summary of findings for the main comparison. Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants
Comparison 1. Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Combined outcome mortality or bronchopulmonary dysplasia at 36 weeks PMA Show forest plot

1

30

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.74, 1.63]

1.1 Ventilated infants

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.87, 1.75]

1.2 Non‐ventilated infants

1

10

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.06, 3.91]

2 Mortality at 28 days PNA Show forest plot

2

51

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.14, 65.90]

2.1 Ventilated infants

2

41

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.14, 65.90]

2.2 Non‐ventilated infants

1

10

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Mortality at 36 weeks PMA Show forest plot

3

61

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.35, 25.78]

3.1 Ventilated infants

3

51

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.35, 25.78]

3.2 Non‐ventilated infants

1

10

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Mortality at hospital discharge Show forest plot

3

53

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.35, 25.78]

4.1 Ventilated infants

3

43

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.35, 25.78]

4.2 Non‐ventilated infants

1

10

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Bronchopulmonary dysplasia at 28 days PNA Show forest plot

1

30

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.72, 1.21]

5.1 Ventilated infants

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.61, 1.29]

5.2 Non‐ventilated infants

1

10

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.71, 1.41]

6 Bronchopulmonary dysplasia at 36 weeks PMA Show forest plot

1

30

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.59, 1.70]

6.1 Ventilated infants

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.69, 1.90]

6.2 Non‐ventilated infants

1

10

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.06, 3.91]

7 Combined outcome mortality and bronchopulmonary dysplasia at 28 days PNA Show forest plot

1

30

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.85, 1.18]

7.1 Ventilated infants

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.83, 1.20]

7.2 Non‐ventilated infants

1

10

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.71, 1.41]

8 Failure to extubate day 7 Show forest plot

5

79

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.66, 0.98]

9 Failure to extubate day 14 Show forest plot

2

27

Risk Ratio (M‐H, Fixed, 95% CI)

0.36 [0.10, 1.33]

10 Failure to extubate at the latest reported moment Show forest plot

6

90

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.45, 0.80]

11 Days of mechanical ventilation Show forest plot

3

45

Mean Difference (IV, Fixed, 95% CI)

3.42 [‐1.30, 8.13]

12 Days of supplemental oxygen Show forest plot

4

141

Mean Difference (IV, Fixed, 95% CI)

0.57 [‐5.92, 7.07]

12.1 Ventilated infants

4

100

Mean Difference (IV, Fixed, 95% CI)

5.53 [‐3.99, 15.05]

12.2 Non‐ventilated infants

2

41

Mean Difference (IV, Fixed, 95% CI)

‐3.74 [‐12.63, 5.14]

13 Open‐label intravenous corticosteroids Show forest plot

4

74

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.26, 1.00]

13.1 Ventilated infants

4

64

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.26, 1.00]

13.2 Non‐ventilated infants

1

10

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

14 Sepsis (clinical suspected or culture proven) Show forest plot

5

107

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.50, 1.64]

14.1 Ventilated infants

5

97

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.44, 1.77]

14.2 Non‐ventilated infants

1

10

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.36, 2.75]

15 Patent ductus arteriosus Show forest plot

1

30

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.16, 6.20]

15.1 Ventilated infants

1

30

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.16, 6.20]

16 Hypertension (> 2 SD) Show forest plot

1

27

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

16.1 Ventilated infants

1

17

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

16.2 Non‐ventilated infants

1

10

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

17 Necrotising enterocolitis Show forest plot

1

27

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.1 Ventilated infants

1

17

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.2 Non‐ventilated infants

1

10

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

18 Intraventricular haemorrhage (any grade) Show forest plot

1

19

Risk Ratio (M‐H, Fixed, 95% CI)

0.6 [0.13, 2.82]

18.1 Ventilated infants

1

19

Risk Ratio (M‐H, Fixed, 95% CI)

0.6 [0.13, 2.82]

19 Days of hospitalisation Show forest plot

1

18

Mean Difference (IV, Fixed, 95% CI)

‐24.70 [‐41.75, ‐7.65]

19.1 Ventilated infants

1

18

Mean Difference (IV, Fixed, 95% CI)

‐24.70 [‐41.75, ‐7.65]

20 Airway resistance Show forest plot

1

18

Mean Difference (IV, Fixed, 95% CI)

21.40 [‐71.11, 113.91]

21 Dynamic lung compliance Show forest plot

1

18

Mean Difference (IV, Fixed, 95% CI)

‐0.22 [‐0.33, ‐0.11]

Figuras y tablas -
Comparison 1. Inhaled corticosteroids versus placebo to reduce bronchopulmonary dysplasia in preterm infants