Budesonide-Surfactant Therapy for Neonatal Respiratory Distress Syndrome in Preterm Infants: A Systematic Review and Meta-Analysis of Respiratory Outcomes

Mahmood Noorishadkam; Sedigheh Ekraminasab; Seyedeh Elham Shams; Hossein Neamatzadeh

doi:10.18502/wjpn.v7i1.17324

Mahmood Noorishadkam Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Sedigheh Ekraminasab Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Seyedeh Elham Shams Department of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran
Hossein Neamatzadeh Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

DOI: https://doi.org/10.18502/wjpn.v7i1.17324

Keywords: Pulmonary surfactant, Neonatal respiratory distress syndrome, Budesonide, Meta-analysis

Abstract

Background: Neonatal respiratory distress syndrome (NRDS) in preterm infants is a critical condition often necessitating urgent medical intervention. This meta-analysis assesses the efficacy and safety of combining surfactant with budesonide for treating NRDS in preterm neonates, emphasizing respiratory outcomes.

Methods: We performed a systematic review of databases (PubMed, Embase, Cochrane Library) following PRISMA guidelines from inception to July 30, 2024. Studies comparing budesonide-surfactant combination therapy to surfactant alone in NRDS were included. Respiratory outcomes evaluated included duration of mechanical ventilation, continuous positive airway pressure (CPAP), length of hospitalization, and frequency of a second surfactant dose. The outcomes were the incidence of bronchopulmonary dysplasia (BPD) and mortality rates. Data from eligible studies were pooled for meta-analysis using a random-effects model.

Results: Ten articles involving 920 infants in the treatment group and 1167 in the control group were analyzed. The combination therapy significantly reduced mechanical ventilation time, hospitalization duration, and CPAP use and decreased the need for a second surfactant dose. The treatment group also showed significantly lower mortality rates (OR = 0.694, 95% CI: 0.52, 0.927, P < 0.05) and BPD incidence (OR = 0.639, 95% CI: 0.525, 0.778, P < 0.001) compared to controls.

Conclusion: Budesonide-surfactant therapy for NRDS in preterm infants effectively reduces mechanical ventilation time and hospitalization. It also significantly lowers mortality rates, the need for a second surfactant dose, and BPD incidence, indicating its potential for widespread application in NICUs. Further large-scale trials are needed to validate these findings and
assess long-term outcomes.