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Meta-Analysis
. 2010 Jan 20;2010(1):CD001079.
doi: 10.1002/14651858.CD001079.pub2.

Prophylactic protein free synthetic surfactant for preventing morbidity and mortality in preterm infants

Roger Soll  1 , Eren Ozek
Affiliations
Meta-Analysis

Prophylactic protein free synthetic surfactant for preventing morbidity and mortality in preterm infants

Roger Soll et al. Cochrane Database Syst Rev. .

Abstract

Background: Respiratory distress syndrome (RDS) is caused by a deficiency or dysfunction of pulmonary surfactant. A variety of surfactant products including protein free synthetic surfactant have been developed and tested in the prevention and treatment of RDS.

Objectives: To assess the effect of prophylactic administration of protein free synthetic surfactant (SS) on mortality, chronic lung disease and other morbidities associated with prematurity in preterm newborns at risk for developing RDS. Subgroup analysis were planned according to the degree of prematurity, surfactant product and dosage schedule.

Search strategy: Searches were made of the The Cochrane Library, MEDLINE, OVID, EMBASE, CINAHL from 1966 to 2009. In addition, previous reviews including cross references and abstracts from the Society for Pediatric Research were searched. No language restrictions were applied.

Selection criteria: Randomized and quasi-randomized controlled trials that compared the effect of protein free SS administered to high risk preterm newborns at or shortly after birth in order to prevent RDS, mortality and complications of prematurity.

Data collection and analysis: Data regarding clinical outcomes was excerpted from the clinical trials by the reviewers. Data were analyzed according to the standards of the Cochrane Neonatal Review Group.

Main results: Studies of prophylactic administration of protein free SS note a variable improvement in the respiratory status and a decrease in respiratory distress syndrome in infants who receive prophylactic protein free SS. The meta-analysis supports a decrease in the risk of pneumothorax (typical relative risk 0.67, 95% CI 0.50, 0.90), pulmonary interstitial emphysema (typical relative risk 0.68, 95% CI 0.50, 0.93), and neonatal mortality (typical relative risk 0.70, 95% CI 0.58, 0.85). No differences were seen in the risk of intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity and cerebral palsy. The meta-analysis supports an increase in the risk of patent ductus arteriosus associated with prophylactic SS administration (typical relative risk 1.11, 95% CI 1.00, 1.22), and an increase in the risk of pulmonary hemorrhage (typical relative risk 3.28, 95% CI 1.50, 7.16).

Authors' conclusions: Prophylactic intratracheal administration of protein free synthetic surfactant to infants at risk of developing respiratory distress syndrome has been demonstrated to improve clinical outcome. Infants who receive prophylactic protein free SS have a decreased risk of pneumothorax, a decreased risk of pulmonary interstitial emphysema, and a decreased risk of neonatal mortality. Infants who receive prophylactic protein free SS have an increased risk of developing patent ductus arteriosus and pulmonary hemorrhage.

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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 which manufacture surfactant preparations (Abbott Laboratories, Ross Laboratories, Chiesi Pharmaceuticals, Dey Laboratories, Burroughs‐Welcome).

Figures

1.1
1.1. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 1 Neonatal mortality.
1.2
1.2. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 2 Mortality prior to hospital discharge.
1.3
1.3. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 3 Mortality at 1 year.
1.4
1.4. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 4 Bronchopulmonary dysplasia.
1.5
1.5. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 5 BPD or death at 28 days.
1.6
1.6. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 6 Pneumothorax.
1.7
1.7. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 7 Pulmonary interstitial emphysema.
1.8
1.8. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 8 Patent ductus arteriosus.
1.9
1.9. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 9 Pulmonary hemorrhage.
1.10
1.10. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 10 Necrotizing enterocolitis.
1.11
1.11. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 11 Intraventricular hemorrhage.
1.12
1.12. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 12 Severe intraventricular hemorrhage.
1.13
1.13. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 13 Retinopathy of prematurity.
1.14
1.14. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 14 Severe retinopathy of prematurity.
1.15
1.15. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 15 Cerebral palsy, 1‐2 years.
1.16
1.16. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 16 Cerebral palsy, moderate/severe.
1.17
1.17. Analysis
Comparison 1 Prophylactic synthetic surfactant, Outcome 17 Survivors not assessed at followup.
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References

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