Efficacy of nebulized salbutamol in transient tachypnea of the newborn: A systematic review and meta-analysis

Transient tachypnea of the newborn (TTN) commonly affects near- and full-term infants and often requires respiratory support. The use of nebulized salbutamol to improve respiratory outcomes has been of interest, though its clinical efficacy remains controversial. This systematic review and meta-analysis aimed to evaluate whether nebulized salbutamol improves clinical outcomes in affected infants. We searched PubMed, Scopus, Embase, and the Cochrane Library for randomized controlled trials (RCTs) evaluating the efficacy of nebulized salbutamol in infants with TTN. We used a random-effects model to calculate mean differences (MDs) with 95% confidence intervals (CIs). Twenty-five studies were included in the systematic review, comprising seventeen RCTs for meta-analysis involving 1,317 infants. The analysis showed that salbutamol significantly decreased the duration of respiratory support (MD: −14.85 hours; 95% CI [−25.05, −4.65]; p = 0.004), duration of continuous positive airway pressure (MD: −18.19 hours; 95% CI [−30.03, −6.35]; p = 0.003), duration of oxygen requirement (MD: −24.57 hours; 95% CI [−35.03, −14.10]; p < 0.001), and length of hospitalization (MD: −1.17 days; 95% CI [−1.69, −0.65]; p < 0.001). However, there was no significant decrease in duration of tachypnea (MD: −9.93 hours; 95% CI [−25.42, 5.56]; p = 0.21) or duration of neonatal intensive care unit stay (MD: −0.84 days; 95% CI [−2.62, 0.94]; p = 0.36). Subgroup analysis for respiratory support duration showed no significant effect in infants with clinical score of TTN < 5 (MD: −10.88 hours; 95% CI [−24.48, 2.73]; p = 0.12), while the certainty of evidence for all outcomes was low to very low. Nebulized salbutamol may improve clinical outcomes relevant to the evolution of the disease in TTN infants, with potential benefits in certain subgroups such as those with greater disease severity, though the available evidence is of low to very low certainty. Therefore, our confidence in its efficacy in treating TTN remains limited.