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Meta-Analysis
. 2009 Apr 15;2009(2):CD007836.
doi: 10.1002/14651858.CD007836.

Animal derived surfactant extract for treatment of respiratory distress syndrome

Nadine Seger  1 , Roger Soll
Affiliations
Meta-Analysis

Animal derived surfactant extract for treatment of respiratory distress syndrome

Nadine Seger et al. Cochrane Database Syst Rev. .

Abstract

Background: Respiratory distress syndrome (RDS) is caused by a deficiency or dysfunction of pulmonary surfactant. A wide variety of surfactant products have been formulated and studied in clinical trials. These include synthetic surfactants and animal derived surfactant extracts. Trials of surfactant replacement have either tried to prevent the development of respiratory distress in high-risk premature infants or treat established respiratory distress in premature infants.

Objectives: To assess the effect of administration of animal derived surfactant extract on mortality, chronic lung disease and other morbidities associated with prematurity in preterm infants with established respiratory distress syndrome. Subgroup analysis were planned according to the specific surfactant product, the degree of prematurity, and the severity of disease.

Search strategy: Searches were made of the Oxford Database of Perinatal Trials, MEDLINE, EMBASE, and CINAHL from 1975 through December 2008. In addition, searches were made of previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants and journal hand searching in the English language.

Selection criteria: Randomized or quazi-randomized controlled trials that compared the effect of animal derived surfactant extract treatment administered to infants with established respiratory distress syndrome in order to prevent complications of prematurity and mortality.

Data collection and analysis: Data regarding clinical outcomes were excerpted from the reports of the clinical trials by the review authors. Data analysis was done in accordance with the standards of the Cochrane Neonatal Review Group.

Main results: Thirteen randomized controlled trials were included in the analysis. The studies demonstrated an initial improvement in respiratory status (improved oxygenation and decreased need for ventilator support). The meta-analysis supports a significant decrease in the risk of any air leak (typical relative risk 0.47, 95% CI 0.39, 0.58; typical risk difference -0.16, 95% CI -0.21, -0.12), pneumothorax (typical relative risk 0.42, 95% CI 0.34, 0.52; typical risk difference -0.17, 95% CI -0.21, -0.13), and a significant decrease in the risk of pulmonary interstitial emphysema (typical relative risk 0.45, 95% CI 0.37, 0.55; typical risk difference -0.20, 95% CI -0.25, -0.15). There is a significant decrease in the risk of neonatal mortality (typical relative risk 0.68, 95% CI 0.57, 0.82; typical risk difference -0.09, 95% CI -0.13, -0.05), a significant decrease in the risk of mortality prior to hospital discharge (typical relative risk 0.63, 95% CI 0.44, 0.90; typical risk difference -0.10, 95% CI -0.18, -0.03) and a significant decrease in the risk of bronchopulmonary dysplasia (BPD) or death at 28 days of age (typical relative risk 0.83, 95% CI 0.77, 0.90; typical risk difference -0.11, 95 CI -0.16, -0.06). No differences are reported in the risk of patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, BPD or retinopathy of prematurity.

Authors' conclusions: Infants with established respiratory distress syndrome who receive animal derived surfactant extract treatment have a decreased risk of pneumothorax, a decreased risk of pulmonary interstitial emphysema, a decreased risk of mortality, and a decreased risk of bronchopulmonary dysplasia or death.

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Conflict of interest statement

Dr. R. Soll has acted as a consultant and invited speaker for several of the pharmaceutical companies that manufacture surfactant preparations (Abbott Laboratories, Ross Laboratories, Chiese Pharmaceuticals, Dey Laboratories, Burroughs Wellcome). N. Seger has no conflict of interest to report.

Figures

1.1
1.1. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 1 Effect on Air Leak.
1.2
1.2. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 2 Effect on Pneumothorax.
1.3
1.3. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 3 Effect on Pulmonary Interstitial Emphysema.
1.4
1.4. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 4 Effect on Pulmonary Hemorrhage.
1.5
1.5. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 5 Effect on Patent Ductus Arteriosus.
1.6
1.6. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 6 Effect on Necrotizing Enterocolitis.
1.7
1.7. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 7 Effect on Sepsis.
1.8
1.8. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 8 Effect on Periventricular/Intraventricular Hemorrhage.
1.9
1.9. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 9 Effect on Severe Periventricular/Intraventricular Hemorrhage.
1.10
1.10. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 10 Effect of Bronchopulmonary Dysplasia.
1.11
1.11. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 11 Effect on Neonatal Mortality.
1.12
1.12. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 12 Effect on Mortality Prior to Hospital Discharge.
1.13
1.13. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 13 Effect on Reported Mortality.
1.14
1.14. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 14 Effect on Bronchopulmonary Dysplasia or Death.
1.15
1.15. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 15 Effect on Retinopathy of Prematurity.
1.16
1.16. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 16 Effect on Severe Retinopathy of Prematurity.
1.17
1.17. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 17 Effect on Cerebral Palsy.
1.18
1.18. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 18 Effect on visual impairment in survivors.
1.19
1.19. Analysis
Comparison 1 Animal derived surfactant extract treatment of RDS (all infants), Outcome 19 Effect on major neurodevelopmental disability in survivors.
2.1
2.1. Analysis
Comparison 2 Animal derived surfactant extract treatment of RDS (infants <1000g), Outcome 1 Effect of Bronchopulmonary Dysplasia.
2.2
2.2. Analysis
Comparison 2 Animal derived surfactant extract treatment of RDS (infants <1000g), Outcome 2 Effect on Neonatal Mortality.
2.3
2.3. Analysis
Comparison 2 Animal derived surfactant extract treatment of RDS (infants <1000g), Outcome 3 Effect on Reported Mortality.
2.4
2.4. Analysis
Comparison 2 Animal derived surfactant extract treatment of RDS (infants <1000g), Outcome 4 Effect on Bronchopulmonary Dysplasia or Death.
3.1
3.1. Analysis
Comparison 3 Animal derived surfactant extract treatment of RDS (infants ≥1000g), Outcome 1 Effect on Pneumothorax.
3.2
3.2. Analysis
Comparison 3 Animal derived surfactant extract treatment of RDS (infants ≥1000g), Outcome 2 Effect on Pulmonary Interstitial Emphysema.
3.3
3.3. Analysis
Comparison 3 Animal derived surfactant extract treatment of RDS (infants ≥1000g), Outcome 3 Effect on Pulmonary Hemorrhage.
3.4
3.4. Analysis
Comparison 3 Animal derived surfactant extract treatment of RDS (infants ≥1000g), Outcome 4 Effect on Patent Ductus Arteriosis.
3.5
3.5. Analysis
Comparison 3 Animal derived surfactant extract treatment of RDS (infants ≥1000g), Outcome 5 Effect on Necrotizing Enterocolitis.
3.6
3.6. Analysis
Comparison 3 Animal derived surfactant extract treatment of RDS (infants ≥1000g), Outcome 6 Effect on Sepsis.
3.7
3.7. Analysis
Comparison 3 Animal derived surfactant extract treatment of RDS (infants ≥1000g), Outcome 7 Effect on Periventricular/Intraventricular Hemorrhage.
3.8
3.8. Analysis
Comparison 3 Animal derived surfactant extract treatment of RDS (infants ≥1000g), Outcome 8 Effect on Severe Periventricular/Intraventricular Hemorrhage.
3.9
3.9. Analysis
Comparison 3 Animal derived surfactant extract treatment of RDS (infants ≥1000g), Outcome 9 Effect on Bronchopulmonary Dysplasia.
3.10
3.10. Analysis
Comparison 3 Animal derived surfactant extract treatment of RDS (infants ≥1000g), Outcome 10 Effect on Neonatal Mortality.
3.11
3.11. Analysis
Comparison 3 Animal derived surfactant extract treatment of RDS (infants ≥1000g), Outcome 11 Effect on Reported Mortality.
3.12
3.12. Analysis
Comparison 3 Animal derived surfactant extract treatment of RDS (infants ≥1000g), Outcome 12 Effect on Bronchopulmonary Dysplasia or Death.
3.13
3.13. Analysis
Comparison 3 Animal derived surfactant extract treatment of RDS (infants ≥1000g), Outcome 13 Effect on Retinopathy of Prematurity.
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