Interventions to Prevent Bronchopulmonary Dysplasia in Preterm Neonates

Abstract

IMPORTANCE Bronchopulmonary dysplasia (BPD) has multifactorial etiology and long-term adverse consequences. An umbrella review enables the evaluation of multiple proposed interventions for the prevention of BPD. OBJECTIVE To summarize and assess the certainty of evidence of interventions proposed to decrease the risk of BPD from published systematic reviews. DATA SOURCES MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, and Web of Science were searched from inception until November 9, 2020. STUDY SELECTION Meta-analyses of randomized clinical trials comparing interventions in preterm neonates that included BPD as an outcome. DATA EXTRACTION AND SYNTHESIS Data extraction was performed in duplicate. Quality of systematic reviews was evaluated using Assessment of Multiple Systematic Reviews version 2, and certainty of evidence was assessed using Grading of Recommendation, Assessment, Development, and Evaluation. MAIN OUTCOMES AND MEASURES (1) BPD or mortality at 36 weeks' postmenstrual age (PMA) and (2) BPD at 36 weeks' PMA.RESULTS A total of 154 systematic reviews evaluating 251 comparisons were included, of which 110 (71.4%) were high-quality systematic reviews. High certainty of evidence from high-quality systematic reviews indicated that delivery room continuous positive airway pressure compared with intubation with or without routine surfactant (relative risk [RR], 0.80 [95% CI, 0.68-0.94]), early selective surfactant compared with delayed selective surfactant (RR, 0.83 [95% CI, 0.75-0.91]), early inhaled corticosteroids (RR, 0.86 [95% CI, 0.75-0.99]), early systemic hydrocortisone (RR, 0.90 [95% CI, 0.82-0.99]), avoiding endotracheal tube placement with delivery room continuous positive airway pressure and use of less invasive surfactant administration (RR, 0.90 [95% CI, 0.82-0.99]), and volume-targeted compared with pressure-limited ventilation (RR, 0.73 [95% CI, 0.59-0.89]) were associated with decreased risk of BPD or mortality at 36 weeks' PMA. Moderate to high certainty of evidence showed that inhaled nitric oxide, lower saturation targets (85%-89%), and vitamin A supplementation are associated with decreased risk of BPD at 36 weeks' PMA but not the competing outcome of BPD or mortality, indicating they may be associated with increased mortality. CONCLUSIONS AND RELEVANCEA multipronged approach of delivery room continuous positive airway pressure, early selective surfactant administration with less invasive surfactant administration, early hydrocortisone prophylaxis in high-risk neonates, inhaled corticosteroids, and volume-targeted ventilation for preterm neonates requiring invasive ventilation may decrease the combined risk of BPD or mortality at 36 weeks' PMA.

Overview of the Effectiveness of Different Surfactant Administration Methods: An Umbrella Review of Meta‐Analyses

“…This is consistent with the 2022 European Consensus guidelines on the Management of RDS, which recommend LISA as the preferred method of surfactant administration [38]. A previous umbrella review reported that LISA would benefit over INSURE against BPD, however, other surfactant administration methods or outcomes were not considered [39].…”

Overview of the Effectiveness of Different Surfactant Administration Methods: An Umbrella Review of Meta‐Analyses

“…This is consistent with the 2022 European Consensus guidelines on the Management of RDS, which recommend LISA as the preferred method of surfactant administration [38]. A previous umbrella review reported that LISA would benefit over INSURE against BPD, however, other surfactant administration methods or outcomes were not considered [39].…”

Endothelial Baf60c Alleviates Hyperoxia-Induced BPD-Associated Pulmonary Hypertension Through Smarcc2 and PI3K-Akt-mTOR Signaling

“…5,6,9 The simplified alveolar phenotype we observed is consistent with arrested alveolar development described in severe BPD and in hyperoxia rodent models. 3,10,11,26,35 Transcriptomic enrichment of chromatin remodeling and DNA-binding processes after hyperoxia fits a broader literature,as well as our previous study 37 showing that neonatal hyperoxia can leave persistent epigenetic marks in lung tissue, including histone signature disturbances at vascular-related loci such as eNOS 37 , NOS3 and STAT3. 14 Integrative reviews similarly emphasize epigenetic–metabolic coupling as an underexplored layer in pulmonary vascular disease.…”

Combining artificial intelligence and conventional statistics to predict bronchopulmonary dysplasia in very preterm infants using routinely collected clinical variables

“…Some limitations of the present study must be acknowledged: study recruitment encompasses a relatively long period, during which several changes have occurred in neonatal resuscitation guidelines and neonatal intensive care practice, including oxygen supplementation, modes of respiratory support, both at birth and during NICU stay, and nutritional practices. Even if in the present study birth year was not found to affect the risk of BPD, those factors might have had an additional impact on the risk of developing BPD 3 and should be considered as potential confounders when planning future studies on this topic. In addition, recent years have witnessed a rising awareness of the importance of maintaining normothermia at birth, 40 as this is associated with improved clinical outcomes in preterm infants, including BPD 41 .…”

Overview of the Effectiveness of Different Surfactant Administration Methods: An Umbrella Review of Meta‐Analyses

“…This is consistent with the 2022 European Consensus guidelines on the Management of RDS, which recommend LISA as the preferred method of surfactant administration [38]. A previous umbrella review reported that LISA would benefit over INSURE against BPD, however, other surfactant administration methods or outcomes were not considered [39].…”

Endothelial Baf60c Alleviates Hyperoxia-Induced BPD-Associated Pulmonary Hypertension Through Smarcc2 and PI3K-Akt-mTOR Signaling

“…5,6,9 The simplified alveolar phenotype we observed is consistent with arrested alveolar development described in severe BPD and in hyperoxia rodent models. 3,10,11,26,35 Transcriptomic enrichment of chromatin remodeling and DNA-binding processes after hyperoxia fits a broader literature,as well as our previous study 37 showing that neonatal hyperoxia can leave persistent epigenetic marks in lung tissue, including histone signature disturbances at vascular-related loci such as eNOS 37 , NOS3 and STAT3. 14 Integrative reviews similarly emphasize epigenetic–metabolic coupling as an underexplored layer in pulmonary vascular disease.…”

Combining artificial intelligence and conventional statistics to predict bronchopulmonary dysplasia in very preterm infants using routinely collected clinical variables

“…Some limitations of the present study must be acknowledged: study recruitment encompasses a relatively long period, during which several changes have occurred in neonatal resuscitation guidelines and neonatal intensive care practice, including oxygen supplementation, modes of respiratory support, both at birth and during NICU stay, and nutritional practices. Even if in the present study birth year was not found to affect the risk of BPD, those factors might have had an additional impact on the risk of developing BPD 3 and should be considered as potential confounders when planning future studies on this topic. In addition, recent years have witnessed a rising awareness of the importance of maintaining normothermia at birth, 40 as this is associated with improved clinical outcomes in preterm infants, including BPD 41 .…”

Overview of the Effectiveness of Different Surfactant Administration Methods: An Umbrella Review of Meta‐Analyses

“…This is consistent with the 2022 European Consensus guidelines on the Management of RDS, which recommend LISA as the preferred method of surfactant administration [38]. A previous umbrella review reported that LISA would benefit over INSURE against BPD, however, other surfactant administration methods or outcomes were not considered [39].…”

Endothelial Baf60c Alleviates Hyperoxia-Induced BPD-Associated Pulmonary Hypertension Through Smarcc2 and PI3K-Akt-mTOR Signaling

“…5,6,9 The simplified alveolar phenotype we observed is consistent with arrested alveolar development described in severe BPD and in hyperoxia rodent models. 3,10,11,26,35 Transcriptomic enrichment of chromatin remodeling and DNA-binding processes after hyperoxia fits a broader literature,as well as our previous study 37 showing that neonatal hyperoxia can leave persistent epigenetic marks in lung tissue, including histone signature disturbances at vascular-related loci such as eNOS 37 , NOS3 and STAT3. 14 Integrative reviews similarly emphasize epigenetic–metabolic coupling as an underexplored layer in pulmonary vascular disease.…”

Combining artificial intelligence and conventional statistics to predict bronchopulmonary dysplasia in very preterm infants using routinely collected clinical variables

“…Some limitations of the present study must be acknowledged: study recruitment encompasses a relatively long period, during which several changes have occurred in neonatal resuscitation guidelines and neonatal intensive care practice, including oxygen supplementation, modes of respiratory support, both at birth and during NICU stay, and nutritional practices. Even if in the present study birth year was not found to affect the risk of BPD, those factors might have had an additional impact on the risk of developing BPD 3 and should be considered as potential confounders when planning future studies on this topic. In addition, recent years have witnessed a rising awareness of the importance of maintaining normothermia at birth, 40 as this is associated with improved clinical outcomes in preterm infants, including BPD 41 .…”