Bronchodilators for the prevention and treatment of chronic lung disease in preterm infants

Ng G, da Silva O, Ohlsson A

Published Online:

October 7, 2009

Not enough evidence to show the effect of bronchodilators for chronic lung disease in preterm babies.

Chronic lung disease (CLD) is common in babies who are born before 34 weeks gestation. Bronchodilators are drugs that cause widening of the air passages in the lungs. They have been used for CLD because of their potential effect of dilating small airways in babies born preterm. Bronchodilators can be inhaled, taken by mouth (a puffer) or injection or by a nebulizer with a pressurized aerosol. This review of trials found that there was not enough evidence to show either positive or negative effects of bronchodilators for CLD. More research is needed.

Abstract (click to read)

Background:

Chronic lung disease (CLD) occurs frequently in preterm infants. Bronchodilators have the potential effect of dilating small airways with muscle hypertrophy. Increase in compliance and tidal volume and decrease in pulmonary resistance have been documented with use of bronchodilators in studies of pulmonary mechanics in infants with CLD. Therefore, it is possible that bronchodilators might have a role in the prevention and treatment of CLD.

Objectives:

To determine the effect of bronchodilators given either prophylactically or as treatment for CLD on mortality and other complications of prematurity in preterm infants at risk for or having CLD.

Search strategy:

Searches were made of MEDLINE 1966 to January 2009, EMBASE 1980 to January 2009, CINAHL 1982 to January 2009, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2009), personal files and reference lists of identified trials. No language restrictions were applied.

Selection criteria:

Randomised controlled trials involving preterm infants were eligible for inclusion. Initiation of bronchodilator therapy had to occur within two weeks of birth for prevention of CLD. For treatment of CLD, treatment had to be initiated before discharge from the neonatal unit. The intervention had to include the administration of a bronchodilator either by nebulisation, metered dose inhaler (with or without a spacer device), intravenously or orally versus placebo or no intervention. Eligible studies had to include at least one of the predefined outcomes.

Data collection and analysis:

We used the standard method described in the Cochrane Collaboration handbook. Two investigators extracted and assessed all data for each study. Relative risk (RR) and risk difference (RD) with 95% confidence intervals (CI) are reported for dichotomous outcomes and mean difference (WMD) for continuous data.

Main results:

One eligible study was found dealing with prevention of CLD; this study used salbutamol and enrolled 173 infants. No eligible studies were found dealing with treatment of CLD. Prophylaxis with salbutamol did not show a statistically significant difference in mortality [RR 1.08 (95% CI 0.50, 2.31); RD 0.01 (95% CI -0.09, 0.11)] or CLD [RR 1.03 (95% CI 0.78, 1.37); RD 0.02 (95% CI -0.13, 0.17)]. No statistically significant differences were seen in other complications associated with CLD or preterm birth. No side effects due to salbutamol were commented on in this study.

Authors' conclusions:

There are insufficient data to reliably assess the use of salbutamol for the prevention of CLD. Further clinical trials are necessary to assess the role of salbutamol or other bronchodilator agents in prophylaxis or treatment of CLD.

This record should be cited as:

Ng G, da Silva O, Ohlsson A. Bronchodilators for the prevention and treatment of chronic lung disease in preterm infants. Cochrane Database of Systematic Reviews 2001, Issue 3. Art. No.: CD003214. DOI: 10.1002/14651858.CD003214

Assessed as up to date:

July 21, 2009

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Primary Review Group:

Neonatal Group

Health topics:

Neonatal care > Bronchopulmonary dysplasia

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Bronchodilators for the prevention and treatment of chronic lung disease in preterm infants

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