Objective  To evaluate the efficacy and safety of budesonide combined with pulmonary surfactant (PS) in the treatment of meconium aspiration syndrome (MAS) in neonates.

Methods  PubMed, Cochrane Central Register of Controlled Trials (Central), Embase,Web of Science, SinoMed, VIP, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of budesonide combined with PS in the treatment of neonatal MAS from inception to September 2, 2023. Two researchers independently screened literature, extracted data and assessed the risk of bias of the included studies, meta-analyses were performed by using the RevMan 5.4 software.

Results  A total of 6 RCTs involving 544 patients were included. The results of meta-analysis showed that compared with PS group, budesonide combined with PS group had higher overall effective rate (RR=1.29, 95%CI 1.17 to 1.41, P<0.001), shorter hospital stay (MD=-6.35, 95%CI -9.25 to -3.46, P<0.001) and shorter time of oxygen inhalation (MD=-1.61, 95%CI -2.23 to -0.98, P<0.001), shorter the duration of ventilator use (MD=-26.46, 95%CI -35.98 to -16.95, P<0.001), improved the blood gas analysis indexes at each time after treatment (P<0.05); In terms of safety, the incidence of total complications and adverse reactions in budesonide combined with PS group was significantly lower (RR=0.35, 95%CI 0.25 to 0.47, P<0.001). Subgroup analysis showed that the incidence of persistent pulmonary hypertension of the newborn (PPHN) in the budesonide combined with PS group was decreased (RR=0.38, 95%CI 0.19 to 0.74, P=0.004), and the incidence of pneumorrhagia was decreased (RR=0.26, 95%CI 0.10 to 0.69, P=0.007), and the difference was statistically significant; the incidence of heart failure and sepsis was not statistically significant compared with the PS group (P>0.05).

Conclusion  Current evidence shows that budesonide combined with PS in the treatment of neonatal meconium aspiration syndrome can improve the symptoms and signs of MAS children, improve the blood gas analysis index, accelerate disease rehabilitation, shorten the course of the disease, can help reduce the risk of complications and PPHN, pneumorrhagia, and doesn't increase the incidence of heart failure, sepsis. Due to the limited quantity of the included studies, more high-quality and large-sample RCTs are needed to further validate the above conclusions.

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