Scenario

An extremely premature infant born at 25 weeks gestation is now corrected to 32 weeks of gestational age (GA). He was invasively ventilated from birth and was extubated to continuous positive airway pressure (CPAP) on the 34th day of life after two failed attempts aided by oral dexamethasone (DART) regime. He has subsequently been switched to high flow nasal cannula. However, over the last week, the flow requirement has increased from 4 L/min to 7 L/min and the average fractional inspired oxygen requirement has increased from 35% to 50%. Sepsis has been ruled out and his growth is optimal on the 50th centile. He has been on diuretics for 2 weeks and a trial of anti-reflux medication has not helped. On review he is tachypnoeic, but his blood gas is within normal limits. A chest X-ray shows bilateral cystic changes with hyperinflated regions in both lungs. There are patchy atelectatic areas and opaque strands but no areas of focal collapse or consolidation.

Clinical question

In this index patient will administration of inhaled budesonide improve respiratory status?

In premature infants, born <32 weeks, does inhaled budesonide (intervention), prevent or reduce the severity of subsequent chronic lung disease (outcome)?

Search

Primary sources: MEDLINE, CINAHL and PubMed from inception to 19 November 2019 using (neonat* OR preterm OR prematu* OR infant) AND (budesonide OR inhaled budesonide) AND (bronchopulmonary dysplasia OR BPD OR chronic lung disease OR CLD). 82 unique articles were identified, 21 full articles reviewed and five are being included in this review (table 1). Studies only involving a comparison to systemic corticosteroids or studies co-administering systemic steroids to both arms were excluded.

Secondary sources: COCHRANE—search with similar Medical Subject Headings terms revealed 348 reviews, eight protocols and six clinical answers. We did not include Cochrane reviews in the citations, to minimise heterogeneity, …