966: LATE (≥ 7 DAYS) SYSTEMIC POSTNATAL CORTICOSTEROIDS FOR BRONCHOPULMONARY DYSPLASIA: A META-ANALYSIS

Introduction: One of the several complications associated with preterm birth is bronchopulmonary dysplasia (BPD), a disorder characterized by abnormal development of the lungs and subsequent breathing problems. We aim to determine the safety and efficacy of late (≥ 7 days) systemic corticosteroids for the prevention of BPD in preterm infants. Methods: We searched electronic databases, international trial registers, grey literature sources, and reference lists of articles to identify relevant randomized controlled trials (RCTs) on the use of systemic corticosteroids for the prevention of BPD. We assessed the risk of bias using the revised Cochrane “Risk of bias” tool for randomized trials (RoB 2.0), calculated risk ratio (RR) with 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) with 95% CI for continuous outcomes. Results: Our meta-analysis included 24 RCTs (2617 infants); 21 RCTs involved dexamethasone while 3 RCTs involved hydrocortisone. Our analysis showed that compared to the control group, late corticosteroids significantly decreased neonatal mortality at various ages: 28 days (RR 0.62, 95% CI 0.40-0.95, I2=0%), 36 weeks postmenstrual age (RR 0.73, 95% CI 0.56-0.95, I2=0%), latest reported age (RR 0.82, 95% CI 0.68-0.99, I2=0%), and before hospital discharge (RR 0.80, 95% CI 0.66-0.98, I2=0%). Late systemic corticosteroids did not significantly affect the incidence of BPD at 28 days after birth (RR 0.91, 95% CI 0.83-1.00, I2=40%) and 36 weeks postmenstrual age (RR 0.90, 95% CI 0.82-1.00, I2=27%). However, late corticosteroids decreased the frequency of late rescue with corticosteroids (RR 0.56, 95% CI 0.43-0.73, I2=61%). Late corticosteroids increased the risk of hyperglycemia, glycosuria, and hypertension. Infants who were administered corticosteroids were also found to have significantly less failure to extubate on the 3rd, 7th, and 14th day after treatment. Conclusions: The use of late systemic corticosteroids is shown to have significantly reduced the mortality in preterm infants, but had no significant effect on the incidence of BPD. More RCTs with longer follow-ups addressing the appropriate dose and timing of steroid therapy are needed.