Article type
Year
Abstract
Objective: To systematically review evidence to determine whether postnatal dx commenced within 14 days of age prevents CLD.
Methods: All randomised controlled trials of dx commenced within 14 days (d) of age were included in the analysis. Systematic search in accordance with Cochrane reviews. Meta-analyses using event rate ratio (ERR), event rate difference (ERD) with 95% confidence limits were used and if significant numbers needed to treat (NNT) were calculated. Three specified subgroup analyses were performed. Subgroup where dx was commenced within 36 hrs of age, subgroup where dx was commenced within 7 to 14 d of age and where surfactant was used.
Results: 8 publications and 2 abstracts were included in the overall analyses. In the subgroup analyses there were 4 publications and 2 abstracts, 4 publications and 5 publications respectively.The ERR's and if significant NNTs are as follows:
All Trials
Outomes ERR CI 95% NNT CI 95%
Death 0.87 0.68, 1.12
CLD at 28d 0.71 0.61, 0.84 8 5, 17
CLD at 36 weeks 0.58 0.45, 0.77 9 6, 21
(w) corrected age
Hypertension 2.50 1.26, 4.96 42 19, 212
Days to regain birthweight (mean + sd ): 3.86+1.08, days in 02 (mean + sd) -19.28 +4.19, days in hospital (mean + sd): -21.96 + 2.71, days on MV (mechanical ventilation) (mean + sd) -8.97 + 1.59.
Subgroups: (1) Dx (<36 hrs of age) (2) Dx (7-14 d of age)
Outcomes ERR(CI 95%) NNT(CI 95%) ERR(CI 95%) NNT(CI 95%)
Death 1.03(0.78, 1.34) 0.35(0.16, 0.74) 8(4, 30)
CLD at 28d 0.64(0.49, 0.83) 8(5, 21) 0.83(0.72, 0.95) 9(5,74)
CLD at 36w 0.53(0.33, 0.83) 13(7, 48) 0.63(0.47, 0.85) 3(2, 9)
Hypertension 2.03(0.82,5.04) 3.78(1.15, 12.38) 65(16, 337)
Subgroup where surfactant therapy was used did not show any difference from the overall analyses.
Discussion: The overall meta-analyses showed a significant reduction in risk of CLD at 28d and 36 w, days in oxygen, days in hospital and days on MV, in addition in the subgroup where surfactant was commenced between 7-14 d there was a significant reduction in death. There was an increase in risk of hypertension and increase in days to regain birthweight in the intervention group. There was a decrease in mean difference in days in hospital, days in 02, and days on MV
Methods: All randomised controlled trials of dx commenced within 14 days (d) of age were included in the analysis. Systematic search in accordance with Cochrane reviews. Meta-analyses using event rate ratio (ERR), event rate difference (ERD) with 95% confidence limits were used and if significant numbers needed to treat (NNT) were calculated. Three specified subgroup analyses were performed. Subgroup where dx was commenced within 36 hrs of age, subgroup where dx was commenced within 7 to 14 d of age and where surfactant was used.
Results: 8 publications and 2 abstracts were included in the overall analyses. In the subgroup analyses there were 4 publications and 2 abstracts, 4 publications and 5 publications respectively.The ERR's and if significant NNTs are as follows:
All Trials
Outomes ERR CI 95% NNT CI 95%
Death 0.87 0.68, 1.12
CLD at 28d 0.71 0.61, 0.84 8 5, 17
CLD at 36 weeks 0.58 0.45, 0.77 9 6, 21
(w) corrected age
Hypertension 2.50 1.26, 4.96 42 19, 212
Days to regain birthweight (mean + sd ): 3.86+1.08, days in 02 (mean + sd) -19.28 +4.19, days in hospital (mean + sd): -21.96 + 2.71, days on MV (mechanical ventilation) (mean + sd) -8.97 + 1.59.
Subgroups: (1) Dx (<36 hrs of age) (2) Dx (7-14 d of age)
Outcomes ERR(CI 95%) NNT(CI 95%) ERR(CI 95%) NNT(CI 95%)
Death 1.03(0.78, 1.34) 0.35(0.16, 0.74) 8(4, 30)
CLD at 28d 0.64(0.49, 0.83) 8(5, 21) 0.83(0.72, 0.95) 9(5,74)
CLD at 36w 0.53(0.33, 0.83) 13(7, 48) 0.63(0.47, 0.85) 3(2, 9)
Hypertension 2.03(0.82,5.04) 3.78(1.15, 12.38) 65(16, 337)
Subgroup where surfactant therapy was used did not show any difference from the overall analyses.
Discussion: The overall meta-analyses showed a significant reduction in risk of CLD at 28d and 36 w, days in oxygen, days in hospital and days on MV, in addition in the subgroup where surfactant was commenced between 7-14 d there was a significant reduction in death. There was an increase in risk of hypertension and increase in days to regain birthweight in the intervention group. There was a decrease in mean difference in days in hospital, days in 02, and days on MV