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Combining surfactant with budesonide has been proposed to prevent BPD, but results from existing randomised controlled trials (RCTs) are conflicting. Individual participant data meta\u2010analysis (IPD\u2010MA) synthesises raw trial data, increasing precision, improving assessment of data quality and enabling subgroup analyses. This IPD\u2010MA aims to examine the effect of surfactant plus budesonide versus surfactant alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We will systematically search medical databases and trial registers for RCTs enrolling preterm infants born at &lt;\u200932\u2009weeks' gestation randomised to intratracheal surfactant alone or surfactant plus budesonide. Studies with major quality concerns will be excluded. Risk of bias will be assessed using Cochrane's RoB 2 tool. Two\u2010stage fixed\u2010effects IPD\u2010MA will be performed with co\u2010primary outcomes of all\u2010cause mortality at hospital discharge and BPD at 36\u2009weeks' postmenstrual age. Subgroups will be examined using treatment\u2010covariate interactions. Certainty of evidence will be assessed using GRADE. A nested prospective meta\u2010analysis will also be conducted. The study is preregistered on PROSPERO (CRD42023456941).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>If effective, surfactant plus corticosteroid would be a low\u2010cost addition to standard care to reduce BPD and increase survival. IPD\u2010MA will allow further insight into treatment effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apa.70638","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T04:27:37Z","timestamp":1781497657000},"page":"2078-2090","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Budesonide and Surfactant Therapy Versus Surfactant Alone on Incidence of Lung Disease in Preterm Infants (\n                    <scp>BEST<\/scp>\n                    Lung): Study Protocol for a Systematic Review and Individual Participant Data Meta\u2010Analysis With Nested Prospective Meta\u2010Analysis"],"prefix":"10.1111","volume":"115","author":[{"given":"James X.","family":"Sotiropoulos","sequence":"first","affiliation":[{"name":"NHMRC Clinical Trials Centre, Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett J.","family":"Manley","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynaecology and Newborn Health The University of Melbourne  Melbourne Victoria Australia"},{"name":"Mercy Perinatal The Mercy Hospital for Women  Melbourne Victoria Australia"},{"name":"Clinical Sciences Murdoch Children's Research Institute  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sol","family":"Libesman","sequence":"additional","affiliation":[{"name":"NHMRC Clinical Trials Centre, Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0731-9092","authenticated-orcid":false,"given":"Namasivayam","family":"Ambalavanan","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2722-0479","authenticated-orcid":false,"given":"Abhik","family":"Das","sequence":"additional","affiliation":[{"name":"Social, Statistical and Environmental Sciences Unit RTI International  Rockville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J. 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