Intervention Review

Steroid therapy for meconium aspiration syndrome in newborn infants

  1. Meredith C Ward1,*,
  2. John KH Sinn2

Editorial Group: Cochrane Neonatal Group

Published Online: 20 OCT 2003

Assessed as up-to-date: 13 JUL 2003

DOI: 10.1002/14651858.CD003485


How to Cite

Ward MC, Sinn JKH. Steroid therapy for meconium aspiration syndrome in newborn infants. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003485. DOI: 10.1002/14651858.CD003485.

Author Information

  1. 1

    Royal Hospital for Women, Department of Neonatology, Randwick, Sydney, NSW, Australia

  2. 2

    Royal North Shore Hospital, Neonatal Unit, St Leonards, New South Wales, Australia

*Meredith C Ward, Department of Neonatology, Royal Hospital for Women, High St, Randwick, Sydney, NSW, Australia. meredithward@yahoo.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 OCT 2003

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Meconium aspiration syndrome may cause severe respiratory distress in the newborn infant, with an associated high morbidity and mortality. A chemical pneumonitis is believed to occur secondary to bile, bile acids and pancreatic secretions contained in meconium. It has therefore been hypothesised that corticosteroids may be of benefit in the management of this condition through their anti-inflammatory properties.

Objectives

The objective of this review was to determine whether steroid therapy for meconium aspiration syndrome decreases the morbidity and mortality associated with this condition without adverse effects.

Search methods

Searches were made of PREMEDLINE and MEDLINE from 1966 to April 2003, CINAHL back to 1982, Current Contents back to 1998, The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2003) and Oxford Database of Perinatal Trials. The search included cross-referencing of previous reviews, and a review of abstracts, conference and symposia proceedings published in Pediatric Research from 1993 to 2003.

Selection criteria

Randomised controlled trials and quasi-randomised trials comparing steroid treatment to no steroid treatment for neonates with meconium aspiration syndrome were considered for this review.

Data collection and analysis

The methodological quality of each trial was assessed independently by each author. Data were extracted, analysed and results reviewed independently by each author. Meta-analysis was performed with RevMan 4.2, using the fixed effects model. Mean difference (MD) and weighted mean differences (WMD) with 95% confidence intervals in brackets for continuous variables and Relative Risk (RR) with 95% confidence intervals for categorical data were reported.

Main results

Three randomised controlled trials were identified. Two trials, by Wu 1999 (50 participants) and Yeh 1977 (35 participants), were included in the review. The trial by Davey 1995, as yet unpublished, was excluded from this review as insufficient information about methodology and results were available. On meta-analysis, there was no significant reduction in mortality [typical RR 0.95 (0.20, 4.58)]. A small but significant increase in duration of oxygen therapy was seen with the use of steroids [WMD 30.0 hours (8.4, 51.6)]. There was no significant difference in duration of hospital stay in the study by Wu 1999 [MD 0.00 days (-3.09, 3.09)]. Duration of mechanical ventilation was reported by Wu 1999 with no significant difference seen [MD -1.10 days (-2.79, 0.59)]. Incidence of air leak was reported by Yeh 1977 with no significant difference detected [RR 0.64 (0.18, 2.26)]. Long-term outcome was not reported in either of the two studies.

Authors' conclusions

At present, there is insufficient evidence to assess the effects of steroid therapy in the management of meconium aspiration syndrome. A further large randomised controlled trial assessing potential benefits and harm would be required to determine its role.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Steroid therapy for meconium aspiration syndrome in newborn infants

More research needed to show whether corticosteroids could reduce complications and mortality in newborn babies with meconium aspiration syndrome.

A bowel movement (meconium) from an unborn baby in stress during labour can enter the lungs when the baby starts to breathe after birth. Suction and/or intubation are used to try and remove the meconium from the baby's breathing passages, but some babies will still develop meconium aspiration syndrome. Those babies will have breathing difficulties which can lead to breathing failure and death. Corticosteroids are anti-inflammatory drugs that have been tried for babies with meconium aspiration syndrome. However, the review of trials found that there is not enough evidence to assess the potential benefits and harms of this treatment.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

針對新生兒之胎糞吸入症候群 (MAS) 所使用的類固醇療法

對於剛出生的嬰兒而言,胎糞吸入症候群可能會引起嚴重的呼吸窘迫,並且會帶來高度的罹病率與死亡率。人們相信,胎糞裡含有的膽汁、膽酸、及胰臟分泌物會導致化學性的肺炎。因此,有種假設的說法認為,在處理這種情況的時候,皮質類固醇類的藥物或許可以透過它們的抗發炎性質而帶來幫助。

目標

本篇回顧的目的,針而言,是要確認類固醇療法是否可以在不產生不良影響的前提下,讓新生兒之胎糞吸入症候群的罹病率與死亡率降低。

搜尋策略

搜尋PREMEDLINE 及MEDLINE (1966年2003年4月) 、CINAHL (向前搜尋到1982) 、Current Contents (向前搜尋到1998) 、Cochrane Central Register of Controlled Trials (CENTRAL, Cochrane Library, Issue 1, 2003) 及Oxford Database of Perinatal Trials。搜尋包括了先前文獻回顧的交互參照、以及摘要回顧、以及自1993 – 2003年發表於Pediatric Research上的研討會及座談會手冊。

選擇標準

對於屬於胎糞吸入症候群的新生兒而言,屬於隨機對照試驗及半隨機化的試驗,將類固醇治療與不使用類固醇的治療進行比較,這些試驗都會列入本篇回顧之考量。

資料收集與分析

每份試驗在方法學方面的品質,都經由每位作者獨立地進行了評估。每位作者都獨立地將資料擷取出來並加以分析,而且還檢視過這些結果。統合分析是以RevMan 4.2來執行,並使用了固定功效的模型。在進行報告的時候,對於連續性的變異數是採取平均差異(MD)與家加權平均差(WMD)加上括號內的95% 信賴區間(95% CI),而對於分類的數據則是採取相對風險(RR)加上95% 信賴區間。

主要結論

當中共確認了3分隨機對照試驗。在本篇回顧當中,收集了 Wu 1999(50名參與者)與 Yeh 1977(35名參與者)所完成的2份試驗。由 Davey 1995所完成的試驗,到目前為止都還沒有被發表出來,而且因為它在方法學以及結果方面,提供的都是不夠充分的資訊,所以就被排除在本篇回顧之外。統合分析之後,在死亡率方面並沒有任何明顯降低的現象【典型的RR 0.95(0.20,4.58)】。使用了類固醇類藥物時,需要使用氧氣治療的時間輕微但有意義的增加【WMD 30.0小時(8.4,51.6)】。在 Wu 1999所完成的研究當中,對於住院時間長度,並沒有明顯的差異【MD 0.00天(−3.09,3.09)】。根據 Wu 1999所提出的報告指出,對於使用機械式呼吸器的期間長度而言,並沒有觀察到任何顯著的差異【MD −1.10天(−2.79,0.59)】。 Yeh 1977報告氣漏之比率的沒有發現任何顯著的差異【RR 0.64(0.18,2.26)】。在這2份研究都沒有報告長期的預後。

作者結論

在目前這個階段,對於處理胎糞吸入症候群而言,並沒有充分的證據能夠評估類固醇療法所帶來的影響。將來還需要有某種更深入的大型隨機對照試驗,針對可能的優點與危害來加以評估,以確認它的角色。

翻譯人

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

針對胎糞吸入症候群的新生兒而言,皮質類固醇類是否能夠減少併發症,並且降低死亡率,還需要有更多的研究來說明。尚未出生的嬰兒,因為分娩期間所承受的壓力而發生了排便(胎糞)行為,當該名嬰兒在生產之後開始呼吸的時候,這些胎糞就有可能進入肺部。醫師們會嘗試著使用抽吸法以及/或是插管法從該名嬰兒的呼吸通道內清除這些胎糞,但是有些嬰兒們還是會有胎糞吸入症候群。那些嬰兒們將會有呼吸方面的問題,而這問題可能會造成呼吸衰竭與死亡。皮質類固醇類是抗發炎的藥物,而且它們已經被試著用在屬於胎糞吸入症候群的嬰兒們身上。然而,本篇試驗的回顧發現,對於這種治療方法的可能優點與危害而言,並沒有充足的證據能夠加以評估。