Efficacy of pharmacologic therapies for reducing bronchopulmonary dysplasia and mortality in preterm infants: a network meta-analysis
Abstract
Background: Bronchopulmonary dysplasia (BPD) is a major complication of prematurity and is associated with substantial respiratory morbidity, impaired growth, and increased mortality in severe cases. Pharmacologic prevention strategies have been evaluated in randomized trials, but their comparative effects remain uncertain.
Aim: This network meta-analysis aimed to summarize the comparative evidence for pharmacologic interventions evaluated for reducing BPD incidence and pre-discharge mortality in preterm infants.
Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science for randomized controlled trials (RCTs) investigating pharmacological therapies for BPD prevention, with a search cutoff of September 1, 2025. Data analysis was conducted using R 4.2.3 software. The primary outcome was BPD incidence, and the secondary outcome was pre-discharge mortality. BPD definitions and assessment timepoints were extracted from individual studies and interpreted considering variation across NIH 2001, NIH 2018, Shennan, or study-specific criteria.
Results: Thirty-six randomized controlled trials involving 11,414 preterm infants were included in the systematic review. Of these, 24 trials contributed to the BPD incidence network, and 19 trials contributed to the pre-discharge mortality network. Several interventions showed comparative signals for lower odds of BPD incidence or pre-discharge mortality when compared with placebo; however, the strength and precision of these…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 11,414 participants or records.
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