Pentoxifylline for the prevention of infants BPD New Cochrane review

Schulzke SM, Kaempfen S, Patole SK, 24 November 2014

Babies who are born early (preterm) often suffer from long-lasting breathing problems known as bronchopulmonary dysplasia, which can lead to poor health in childhood and adulthood. Drugs that act on the body's self-defense system may help to lower the risk of long-lasting breathing problems. Pentoxifylline is one such drug. The main aim of this review was to find out whether pentoxifylline compared with placebo (an inactive drug) or no drug offers important advantages to babies born early. Only one study of moderate size and quality was identified in this review. This study did not show strong evidence that pentoxifylline offers important advantages to babies born early. We have therefore been unable to determine the effects of pentoxifylline in preventing long-lasting breathing problems in babies born early. Future high-quality studies are needed to answer this question.

Background: 

Bronchopulmonary dysplasia (BPD) is a common complication in preterm infants. BPD is associated with poor long-term respiratory and neurodevelopmental outcome and increased mortality. The prophylactic use of agents that modulate inflammation such as pentoxifylline, a synthetic methylxanthine and phosphodiesterase inhibitor, may reduce the incidence of BPD.

Objectives: 

The primary objective of this review was to determine the effect of pentoxifylline on the incidence of BPD, death prior to 36 weeks postmenstrual age (PMA), and BPD or death prior to 36 weeks PMA in preterm neonates.

Main results: 

We identified one randomised clinical trial eligible for inclusion in this review. This study compared the use of nebulised pentoxifylline versus placebo for prevention of BPD in 100 preterm infants and was at high risk of bias due to lack of blinding of intervention and outcome assessors, and incomplete outcome data. There was no statistically significant effect of nebulised pentoxifylline versus placebo on individual outcomes of BPD at 36 weeks PMA or on death prior to 36 weeks PMA. There was no significant effect of nebulised pentoxifylline on intraventricular haemorrhage, periventricular leukomalacia, sepsis, or patent ductus arteriosus (PDA) requiring ligation. The study did not report any of the other secondary outcomes considered for this review. Reporting of adverse events was very limited and did not allow for reliable judgement on the incidence of such events. No long-term outcomes were reported.

Authors' conclusions: 

There is insufficient evidence to determine the safety and efficacy of pentoxifylline for prevention of BPD in preterm neonates. We encourage researchers to conduct clinical trials to confirm or refute the role of pentoxifylline for prevention of BPD in preterm neonates. These trials should report on clinically important outcomes and, ideally, on long-term neurodevelopmental outcome.