Salbutamol for transient tachypnea of the newborn.

Abstract

BACKGROUND\nTransient tachypnea of the newborn is characterized by tachypnea and signs of respiratory distress. Transient tachypnea typically appears within the first two hours of life in term and late preterm newborns. Although transient tachypnea of the newborn is usually a self-limited condition, it is associated with wheezing syndromes in late childhood. The rationale for the use of salbutamol (albuterol) for transient tachypnea of the newborn is based on studies showing that β-agonists can accelerate the rate of alveolar fluid clearance. This review was originally published in 2016 and updated in 2020.\n\n\nOBJECTIVES\nTo assess whether salbutamol compared to placebo, no treatment or any other drugs administered to treat transient tachypnea of the newborn, is effective and safe for infants born at 34 weeks gestational age with this diagnosis.\n\n\nSEARCH METHODS\nWe searched the Cochrane Central Register of Controlled Trials (CENTRAL, 2020, Issue 4) in the Cochrane Library; PubMed\xa0(1996 to April\xa02020), Embase (1980 to April 2020); and CINAHL (1982 to April 2020). We applied no language restrictions. We searched the abstracts of the major congresses in the field (Perinatal Society of Australia New Zealand and Pediatric Academic Societies) from 2000 to 2020 and clinical trial registries.\n\n\nSELECTION CRITERIA\nRandomized controlled trials, quasi-randomized controlled trials and cluster trials comparing salbutamol versus placebo or no treatment or any other drugs administered to infants born at 34 weeks gestational age or more and less than three days of age with transient tachypnea of the newborn.\n\n\nDATA COLLECTION AND ANALYSIS\nWe used standard Cochrane methodology for data collection and analysis. The primary outcomes considered in this review were duration of oxygen therapy, need for continuous positive airway pressure and need for mechanical ventilation.\xa0We used the GRADE approach to assess the certainty of evidence.\n\n\nMAIN RESULTS\nSeven trials, which included 498 infants, met the inclusion criteria. All\xa0trials compared a nebulized dose of salbutamol with normal saline.\xa0Four studies used one single dose of salbutamol; in two studies,\xa0three to four doses were provided; in one study, additional doses were administered if needed.\xa0The certainty of the evidence was low for\xa0duration of hospital stay and very low for the other outcomes.\xa0Among the primary outcomes of this review, four trials (338\xa0infants) reported the duration of oxygen therapy, (mean difference (MD) -19.24 hours, 95% confidence interval (CI) -23.76 to -14.72); one trial (46 infants) reported the\xa0need for continuous positive airway pressure (risk ratio (RR) 0.73, 95% CI 0.38 to 1.39; risk difference (RD) -0.15, 95% CI -0.45 to 0.16),\xa0and three trials (254 infants) reported the need for mechanical ventilation (RR 0.60, 95% CI 0.13 to 2.86; RD -0.01, 95% CI -0.05 to 0.03). Both duration of hospital stay (4 trials; 338 infants) and duration of respiratory support (2 trials, 228 infants)\xa0were shorter in the salbutamol group\xa0(MD -1.48, 95% CI -1.8 to -1.16; MD -9.24, 95% CI -14.24 to -4.23, respectively). One trial (80 infants) reported duration of mechanical ventilation\xa0and pneumothorax but\xa0data could not be extracted due to the reporting of these outcomes (type of units\xa0of effect measure and unclear\xa0number of events, respectively). Five trials are ongoing.\n\n\nAUTHORS CONCLUSIONS\nThere was limited evidence to establish the benefits and harms\xa0of salbutamol in the management of transient tachypnea of the newborn.\xa0We are uncertain whether\xa0salbutamol administration reduces the\xa0duration of oxygen therapy, duration of tachypnea,\xa0need for continuous positive airway pressure and for mechanical ventilation. Salbutamol\xa0may slightly reduce hospital stay.\xa0Five trials are ongoing. Given the limited and low certainty of the evidence available, we could not\xa0determine whether salbutamol was safe or effective for the treatment of transient tachypnea of the newborn.