Steroid Use for Established Bronchopulmonary Dysplasia: Study Protocol for a Systematic Review and Meta-analysis.

Abstract BackgroundBronchopulmonary dysplasia (BPD) is a serious chronic respiratory condition that affects approximately 60% of preterm infants born before 27 weeks’ gestation, and leads to both, short and long-term pulmonary and non-pulmonary complications. Infants suffering from BPD are difficult to wean off of respiratory support, delaying feeding advancement and hospital discharge. Postnatal steroids during the first three weeks of life have been demonstrated to be effective in decreasing the incidence of BPD, however concerns in relation to neurodevelopmental outcomes are reported as well. On the contrary, data regarding the use of late postnatal steroids, once BPD is established are sparse and inconsistent. Here, we report a protocol for a systematic review, which aims to determine the efficacy and long-term safety of post-natal steroids for the treatment of established BPD in preterm infants.MethodsMEDLINE, Embase, Cochrane databases and sources of grey literature will be searched with no time or language restriction for studies that evaluated the use of postnatal steroids for preterm infants with established BPD. Odds ratios and 95% confidence intervals will be determined and pooled using a random effects model. For the studies that cannot be combined in the meta-analysis, a narrative synthesis of the results will be provided. DiscussionThe use of steroids as a therapeutic option for established BPD, after reaching the critical phase of the disease, is limited by the concern of possible neurological side effects that were documented for the preventive use of this medication. However, steroid treatment for established BPD may be administered in an attempt to reduce length of stay and home oxygen therapy, which are both associated with high levels of parental stress and healthcare costs. Moreover, a late timing for steroid treatment may show a more favourable safety profile in terms of neurodevelopment outcomes, considering the added postnatal brain maturation of these infants. As BPD is one of the neonatal complications that lack an effective course-modifying treatment approach to-date, the proposed systematic review offers considerable clinical relevance.Systematic review registration The protocol is registered in the PROSPERO register (registration number CRD42021218881).