2.
| Inhaled steroids compared with systemic corticosteroids for preventing bronchopulmonary dysplasia among all randomised | ||||||
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Patient or population: Preterm neonates with respiratory distress Settings: NICU Intervention: Inhaled steroids Comparison: Systemic steroids | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Systemic steroids | Inhaled steroids | |||||
| Duration of mechanical ventilation (days) | The mean duration of mechanical ventilation ranged across the systemic steroid groups from 15.2 to 17.9 days | The mean duration of mechanical ventilation ranged across the inhaled steroid groups from 20 to 21 days | 3.89 days (0.24 to 7.55) | 294 (2) | ⊕⊕⊕⊝ moderate | Bias: The risk of bias for these two studies was high. The larger study was not blinded at all sites. Only 53/135 infants randomised to systemic steroids received full course while 53/145 infants randomised to inhaled steroids received full course. The smaller study was not blinded and it was stopped prematurely. We downgraded the Quality of the evidence by one step.
Heterogeneity/Consistency: There was no heterogeneity for this analysis I² = 0%.
Directness of the evidence: The study was conducted in the target population of newborn infants. Precision: Precison for the point estimate was acceptable. Presence of publication bias: N/A. |
| Duration of supplemental oxygen (days) | The mean duration of supplemental oxygen ranged across control groups from 22.7 to 49.3 days | The mean duration of supplemental oxygen in the intervention groups ranged from 38.2 to 53.0 days | 11.10 days (1.97 to 20.22) | 294 (2) | ⊕⊕⊕⊝ moderate | Bias: The risk of bias for these two studies was high. The larger study was not blinded at all sites. Only 53/135 infants randomised to systemic steroids received full course while 53/145 infants randomised to inhaled steroids received full course. The smaller study was not blinded and it was stopped prematurely. We downgraded the Quality of the evidence by one step.
Heterogeneity/Consistency: There was low heterogeneity for this analysis I² = 33%.
Directness of the evidence: The study was conducted in the target population of newborn infants. Precision: Precison for the point estimate was acceptable. Presence of publication bias: N/A. |
| Hyperglycaemia | 533 per 1000 | 280 per 1000 | RR 0.52, (95% CI 0.39 to 0.71) | 278 (1) | ⊕⊕⊕⊝ moderate | Bias: The risk of bias for this single study was high. The study was not blinded at all sites. Only 53/135 infants randomised to systemic steroids received full course while 53/145 infants randomised to inhaled steroids received full course. We downgraded the Quality of the evidence by one step.
Heterogeneity/Consistency: Heterogeneity was N/A as there was only one study included in the analysis.
Directness of the evidence: The study was conducted in the target population of newborn infants. Precision: Precison for the point estimate was acceptable. Presence of publication bias: N/A. |
| Patent ductus arteriosus | 333 per 1000 | 546 per 1000 | RR 1.64, (95% CI 1.23 to 2.17) | 278 (1) | ⊕⊕⊕⊝ moderate | Bias: The risk of bias for this single study was high. The study was not blinded at all sites. Only 53/135 infants randomised to systemic steroids received full course while 53/145 infants randomised to inhaled steroids received full course. We downgraded the Quality of the evidence by one step.
Heterogeneity/Consistency: Heterogeneity was N/A as there was only one study included in the analysis.
Directness of the evidence: The study was conducted in the target population of newborn infants. Precision: Precison for the point estimate was acceptable. Presence of publication bias: N/A. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio; N/A: Not applicable. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||