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Meta-Analysis
. 2012 Mar 14;2012(3):CD000510.
doi: 10.1002/14651858.CD000510.pub2.

Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants

Maria Ximena Rojas-Reyes  1 , Colin J Morley, Roger Soll
Affiliations
Meta-Analysis

Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants

Maria Ximena Rojas-Reyes et al. Cochrane Database Syst Rev. .

Abstract

Background: Surfactant therapy is effective in improving the outcome of very preterm infants. Trials have studied a wide variety of surfactant preparations used either to prevent or treat respiratory distress syndrome (RDS). In animal models, prophylactic surfactant leads to more homogeneous distribution and less evidence of lung damage. However, administration requires intubation and treatment of infants who will not go on to develop RDS. This is of particular concern with the advent of improved approaches to providing continuous distending pressure, particularly in the form of nasal continuous positive airway pressure (CPAP).

Objectives: To compare the effect of prophylactic surfactant administration to surfactant treatment of established RDS in very preterm infants at risk of RDS.

Search methods: We updated the search of the Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, CINAHL, and clinical trials.gov register in December 13, 2011.

Selection criteria: Randomized and quasi-randomized controlled trials that compared the effects of prophylactic surfactant administration to surfactant treatment of established RDS in preterm infants at risk of RDS.

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

Main results: Eleven studies were identified that met inclusion criteria [nine without routine application of continuous positive air way pressure (CPAP) in the selective treatment group; two with routine application of CPAP in the selective treatment group]The meta-analysis of studies conducted prior to the routine application of CPAP demonstrated a decrease in the risk of air leak and neonatal mortality associated with prophylactic administration of surfactant. However, the analyses of studies that allowed for routine stabilization on CPAP demonstrated a decrease in the risk of chronic lung disease or death in infants stabilized on CPAP. When all studies were evaluated together, the benefits of prophylactic surfactant could no longer be demonstrated.

Authors' conclusions: Although the early trials of prophylactic surfactant administration to infants judged to be at risk of developing RDS compared to selective use of surfactant in infants with established RDS demonstrated a decreased risk of air leak and mortality, recent large trials that reflect current practice (including greater utilization of maternal steroids and routine post delivery stabilization on CPAP) do not support these differences and demonstrate less risk of chronic lung disease or death when using early stabilization on CPAP with selective surfactant administration to infants requiring intubation.

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Conflict of interest statement

Dr. MX Rojas has participated as co‐investigator of independent trials supported in part by Abbott Laboratories and Fisher and Pickell Ind.

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 Wellcome).

Dr. C. Morley is a consultant to Fisher and Paykel Healthcare and is paid for lecturing on behalf of Drager Medical.

Figures

1.1
1.1. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 1 Neonatal mortality.
1.2
1.2. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 2 Mortality at 36 weeks PMA or prior to hospital discharge.
1.3
1.3. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 3 Bronchopulmonary dysplasia (oxygen requirement at 28 to 30 days of age).
1.4
1.4. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 4 Bronchopulmonary dysplasia or death at 28 to 30 days of age.
1.5
1.5. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 5 Chronic lung disease.
1.6
1.6. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 6 Chronic lung disease or death.
1.7
1.7. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 7 Any air leak syndromes (including pulmonary interstitial emphysema, pneumothorax, pneumomediastinum).
1.8
1.8. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 8 Pneumothorax.
1.9
1.9. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 9 Pulmonary interstitial emphysema.
1.10
1.10. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 10 Any pulmonary hemorrhage.
1.11
1.11. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 11 Patent ductus arteriosus.
1.12
1.12. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 12 Sepsis.
1.13
1.13. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 13 Necrotizing enterocolitis.
1.14
1.14. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 14 Intraventricular hemorrhage (in infants receiving cranial ultrasound).
1.15
1.15. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 15 Severe intraventricular hemorrhage.
1.16
1.16. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 16 Retinopathy of prematurity (in infants screened).
1.17
1.17. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 17 Retinopathy of prematurity, Stage 2 or more.
1.18
1.18. Analysis
Comparison 1 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants, Outcome 18 Periventricular Leukomalacia.
2.1
2.1. Analysis
Comparison 2 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants less than 30 weeks gestation, Outcome 1 Neonatal mortality.
2.2
2.2. Analysis
Comparison 2 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants less than 30 weeks gestation, Outcome 2 Bronchopulmonary dysplasia (oxygen requirement at 28 to 30 days of age).
2.3
2.3. Analysis
Comparison 2 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants less than 30 weeks gestation, Outcome 3 Bronchopulmonary dysplasia or death at 28 to 30 days of age.
2.4
2.4. Analysis
Comparison 2 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants less than 30 weeks gestation, Outcome 4 Chronic lung disease.
2.5
2.5. Analysis
Comparison 2 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants less than 30 weeks gestation, Outcome 5 Chronic lung disease or death.
3.1
3.1. Analysis
Comparison 3 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants who have mostly received steroids, Outcome 1 Neonatal mortality.
3.2
3.2. Analysis
Comparison 3 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants who have mostly received steroids, Outcome 2 Bronchopulmonary dysplasia (oxygen requirement at 28 to 30 days of age).
3.3
3.3. Analysis
Comparison 3 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants who have mostly received steroids, Outcome 3 Bronchopulmonary dysplasia or death at 28 to 30 days of age.
3.4
3.4. Analysis
Comparison 3 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants who have mostly received steroids, Outcome 4 Chronic lung disease.
3.5
3.5. Analysis
Comparison 3 Prophylactic surfactant vs. treatment of established respiratory distress in preterm infants who have mostly received steroids, Outcome 5 Chronic lung disease or death.
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Update of

References

References to studies included in this review

Bevilacqua 1996 {published data only}
    1. Bevilacqua G, Parmigiani S, Robertson B and the Italian Collaborative Multicentre Study Group. Prophylaxis of respiratory distress syndrome by treatment with modified porcine surfactant at birth: a multicentre prospective randomized trial. Journal of Perinatal Medicine 1996;24:1‐12. - PubMed
Bevilacqua 1997 {published data only}
    1. Bevilacqua G, Chernev T, Parmigiani S, Yarakova N, Gaioni L, Volante E, et al. Use of surfactant for prophylaxis versus rescue treatment of respiratory distress syndrome: experience from an Italian‐Bulgarian trial. Acta Biomed Ateneo Parmense 1997;68(Suppl 1):47‐54. - PubMed
Dunn 1991 {published data only}
    1. Dunn MS, Shennan AT, Zyack D, Possmayer F. Bovine surfactant replacement therapy in neonates of less than 30 weeks' gestation: a randomized controlled trial of prophylaxis vs treatment. Pediatrics 1991;87:377‐86. - PubMed
Dunn 2011 {published and unpublished data}
    1. Dunn M, Kaempf J, Klerk A, Klerk R, Reilly M, Howard D, et al. Delivery room management of preterm infants at risk for respiratory distress syndrome (RDS). Pediatric Academic Societies Conference Proceedings. 2010.
    1. Dunn MS, Kaempf J, Klerk A, Klerk R, Reilly M, Howard D, et al. for the Vermont Oxford Network DRM Study Group. Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics 2011;128:e1069‐76. - PubMed
Egberts 1993 {published data only}
    1. Egberts J, Winter JP, Sedin G, Kleine MJK, Broberger U, Bel F, et al. Comparison of prophylaxis and rescue treatment with Curosurf in neonates less than 30 weeks gestation: a randomized trial. Pediatrics 1993;92:768‐74. - PubMed
Iarŭkova 1999 {published data only (unpublished sought but not used)}
    1. Iarŭkova N, Vakrilova L, Slŭncheva B, Dancheva S, Popivanova A, Emilova Z, et al. Administration of exogenous surfactant in very low birth weight infants with RDS. Akuserstvo i Ginekologija 1999;38:23‐6. [ISSN 0324‐0959 ] - PubMed
Kattwinkel 1993 {published data only}
    1. Kattwinkel J, Bloom BT, Delmore P, Davis CL, Farrell E, Friss H, et al. Prophylactic administration of calf lung surfactant extract is more effective than early treatment of respiratory distress syndrome in neonates of 29 through 32 weeks' gestation. Pediatrics 1993;92:90‐8. - PubMed
Kendig 1991 {published data only}
    1. Kendig JW, Notter RH, Cox C, Reubens LJ, Davis JM, Maniscalco WM. A comparison of surfactant as immediate prophylaxis and as rescue therapy in newborns of less than 30 weeks' gestation. New England Journal of Medicine 1991;324:865‐71. - PubMed
    1. Sinkin RA, Kramer BM, Merzbach JL, Myers GJ, Brooks JG, Palumbo DR, et al. School‐age follow‐up of prophylactic versus rescue surfactant trial: pulmonary, neurodevelopmental, and educational outcomes. Pediatrics 1998;101:E11. - PubMed
Merritt 1991 {published data only}
    1. Merritt TA, Hallman M, Berry C, Pohjavuori M, Edwards DK, Jaaskelainen J, et al. Randomized, placebo‐controlled trial of human surfactant given at birth vs rescue administration in very low birthweight infants with lung immaturity. Journal of Pediatrics 1991;118:581‐94. - PubMed
    1. Vaucher YE, Harker L, Merritt TA, Hallman M, Gist K, Bejar R, et al. Outcome at twelve months of adjusted age in very low birth weight infants with lung immaturity: a randomized, placebo‐controlled trial of human surfactant. Journal of Pediatrics 1993;122:126‐32. - PubMed
SUPPORT 2010 {published data only}
    1. SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Early CPAP versus surfactant in extremely preterm infants. New England Journal of Medicine 2010;362:1970‐9. - PMC - PubMed
Walti 1995 {published data only}
    1. Walti H, Paris‐Llado J, Breart G, Couchard M, and the French Collaborative Multicentre Study Group. Porcine surfactant replacement therapy in newborns of 25‐31 weeks' gestation: a randomized multicentre trial of prophylaxis versus rescue with multiple low doses. Acta Paediatrica 1995;84:913‐21. - PubMed

References to studies excluded from this review

Lefort 2003 {published data only}
    1. Lefort S, Diniz EM, Vaz FA. Clinical course of premature infants intubated in the delivery room, submitted or not to porcine‐derived lung surfactant therapy within the first hour of life. Journal of Maternal‐Fetal and Neonatal Medicine 2003;14:187‐96. - PubMed
Morley 2008 {published data only}
    1. Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB, COIN Trial Investigators. Nasal CPAP or intubation at birth for very preterm infants. The New England Journal of Medicine 2008;358:700‐8. - PubMed
Rojas 2009 {published data only}
    1. Rojas MA, Lozano JM, Rojas MX, Laughon M, Bose CL, Rondon MA, et al. Very early surfactant without mandatory ventilation in premature infants treated with early continuous positive airway pressure: a randomized, controlled trial. Pediatrics 2009;123:137‐42. - PubMed
Sandri 2010 {published data only}
    1. Sandri F, Plavka R, Ancora G, Simeoni U, Stranak Z, Martinelli S, et al. Prophylactic or early selective surfactant combined with nCPAP in very preterm infants. Pediatrics 2010;125:e1402‐9. - PubMed

Additional references

Avery 1987
    1. Avery ME, Tooley WH, Keller JB, Hurd SS, Bryan MH, Cotton RB, et al. Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. Pediatrics 1987;79:26‐30. - PubMed
Bjorklund 1997
    1. Bjorklund LJ, Ingimarsson J, Curstedt T, John J, Robertson B, Werner O, et al. Manual ventilation with a few large breaths at birth compromises the therapeutic effect of subsequent surfactant replacement in immature lambs. Pediatric Research 1997;42:348‐55. - PubMed
D'Angio 2002
    1. D'Angio CT, Sinkin RA, Stevens TP, Landfish NK, Merzbach JL, Ryan RM, et al. Longitudinal, 15‐year follow‐up of children born at less than 29 weeks gestation after introduction of surfactant therapy into a region: neurologic, cognitive, and educational outcomes. Pediatrics 2002;110:1094‐102. - PubMed
Dickersin 2002
    1. Dickersin K, Manheimer E, Wieland S, Robinson KA, Lefebvre C, McDonald S. Development of the Cochrane Collaboration's CENTRAL Register of controlled clinical trials. Evaluation and the Health Professions 2002;25:38‐64. - PubMed
Engle 2008
    1. Engle WA, American Academy of Pediatrics Committee on Fetus and Newborn. Surfactant‐replacement therapy for respiratory distress in the preterm and term neonate. Pediatrics 2008;121:419‐32. - PubMed
Finer 2004
    1. Finer NN, Carlo WA, Duara S, Fanaroff AA, Donovan EE, Wright L, et al. Delivery room continuous positive airway pressure/positive end‐expiratory pressure in extremely low birth weight infants: A feasibility trial. Pediatrics 2004;114:651‐7. - PubMed
Gittermann 1997
    1. Gittermann MK, Fusch C, Gittermann AR, Regazzoni BM, Moessinger AC. Early nasal continuous positive airway pressure treatment reduces the need for intubation in very low birth weight infants. European Journal of Pediatrics 1997;156:384‐8. - PubMed
Greenough 2007
    1. Greenough A, Donn SM. Matching ventilatory support strategies to respiratory pathophysiology. Clinics in Perinatology 2007;34:35‐53. - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ. 2003 Sep;6;327(7414):557‐60. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Ho 2002
    1. Ho JJ, Subramaniam P, Henderson‐Smart DJ, Davis PG. Continuous distending pressure for respiratory distress in preterm infants. Cochrane Database of Systematic Reviews 2002, Issue 2. [DOI: 10.1002/14651858.CD002271] - DOI - PubMed
Horbar 1993
    1. Horbar JD, Wright EC, Onstad L. Decreasing mortality associated with the introduction of surfactant therapy: an observational study of neonates weighing 601‐1300 grams at birth. The Members of the National Institute of Child Health and Human Development Neonatal Research Network. Pediatrics 1993;92:191‐6. - PubMed
Ikegami 1998
    1. Ikegami M, Wada K, Emerson GA, Rebello CM, Hernandez RE, Jobe AH. Effects of ventilation style on surfactant metabolism and treatment response in preterm lambs. American Journal of Respiratory and Critical Care Medicine 1998;157:638‐44. - PubMed
Jobe 1984
    1. Jobe A, Ikegami M, Jacobs H, Jones S. Surfactant and pulmonary blood flow distributions following treatment of premature lambs with natural surfactant. Journal of Clinical Investigation 1984;73:848‐56. - PMC - PubMed
Jobe 1993
    1. Jobe AH. Pulmonary surfactant therapy. New England Journal of Medicine 1993;328:861‐8. - PubMed
Jobe 1998
    1. Jobe AH, Ikegami M. Mechanisms initiating lung injury in the preterm. Early Human Development 1998;53:81‐94. - PubMed
Lindner 1999
    1. Lindner W, Vossbeck S, Hummler H, Pohlandt F. Delivery room management of extremely low birth weight infants: spontaneous breathing or intubation?. Pediatrics 1999;103:961‐7. - PubMed
Nilsson 1978
    1. Nilsson R, Grossman G, Robertson B. Lung surfactant and the pathogenesis of neonatal bronchiolar lesions induced by artificial ventilation. Pediatric Research 1978;12:249‐55. - PubMed
Nowadsky 2009
    1. Nowadzky T, Pantoja A, Britton JR. Bubble continuous positive airway pressure, a potentially better practice, reduces the use of mechanical ventilation among very low birth weight infants with respiratory distress syndrome. Pediatrics 2009;123:1534‐40. - PubMed
Palta 2000
    1. Palta M, Sadek‐Badawi M, Evans M, Weinstein MR, McGuinness G. Functional assessment of a multicenter very low birth‐weight cohort at age 5 years. Newborn Lung Project. Archives of Pediatrics and Adolescent Medicine 2000;154:23‐30. - PubMed
Pfister 2007
    1. Pfister RH, Soll RF, Wiswell T. Protein containing synthetic surfactant versus animal derived surfactant extract for the prevention and treatment of respiratory distress syndrome. Cochrane Database of Systematic Reviews 2007, Issue 4. [DOI: 10.1002/14651858.CD006180.pub2] - DOI - PubMed
Pfister 2009
    1. Pfister RH, Soll R, Wiswell TE. Protein‐containing synthetic surfactant versus protein‐free synthetic surfactant for the prevention and treatment of respiratory distress syndrome. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD006180.pub2] - DOI - PubMed
Possmayer 1990
    1. Possmayer F. The role of surfactant‐associated proteins. American Review of Respiratory Disease 1990;142:749‐52. [PubMed PMID: 2221577] - PubMed
Rider 1992
    1. Rider ED, Jobe AH, Ikegami M, Sun B. Different ventilation strategies alter surfactant responses in preterm rabbits. Journal of Applied Physiology 1992;73:2089‐96. - PubMed
Roberts 2006
    1. Roberts D, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database of Systematic Reviews 2006, Issue 3. [DOI: 10.1002/14651858.CD004454.pub2] - DOI - PubMed
Sahni 1998
    1. Sahni R, Wung JT. Continuous positive airway pressure (CPAP). Indian Journal of Pediatrics 1998;65:265‐71. - PubMed
Schwartz 1994
    1. Schwartz RM, Luby AM, Scanlon JW, Kellogg RJ. Effect of surfactant on morbidity, mortality and resource use in newborn infants weighing 500‐1500 gms. New England Journal of Medicine 1994;330:1476‐80. - PubMed
Schürch 1992
    1. Schürch S, Possmayer F, Cheng S, Cockshutt AM. Pulmonary SP‐A enhances adsorption and appears to induce surface sorting of lipid extract surfactant. American Journal of Physiology 1992;263:L210‐8. [PubMed PMID: 1514646] - PubMed
Seger 2009
    1. Seger N, Soll R. Animal derived surfactant extract for treatment of respiratory distress syndrome. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD007836] - DOI - PubMed
Seidner 1995
    1. Seidner SR, Ikegami M, Yamada T, Rider ED, Castro R, Jobe AH. Decreased surfactant dose‐response after delayed administration to preterm rabbits. American Journal of Respiratory & Critical Care Medicine 1995;152:113‐20. - PubMed
Sinkin 1998
    1. Sinkin RA, Kramer BM, Merzbach JL, Myers GJ, Brooks JG, Palumbo DR, et al. School‐age follow‐up of prophylactic versus rescue surfactant trial: pulmonary, neurodevelopmental, and educational outcomes. Pediatrics 1998;101:E11. - PubMed
Soll 1992
    1. Soll RF, McQueen MC. Respiratory Distress Syndrome. Sinclair J, Bracken M: Effective Care of the Newborn. New York: Oxford University Press, 1992:325‐58. [ISBN 0‐19‐261737‐0]
Soll 2000
    1. Soll RF. Synthetic surfactant for respiratory distress syndrome in preterm infants. Cochrane Database of Systematic Reviews 2000, Issue 2. [DOI: 10.1002/14651858.CD001149; PubMed PMID:10796417] - DOI - PMC - PubMed
Soll 2001
    1. Soll RF, Blanco F. Natural surfactant extract versus synthetic surfactant for neonatal respiratory distress syndrome. Cochrane Database of Systematic Reviews 2001, Issue 2. [DOI: 10.1002/14651858.CD000144] - DOI - PubMed
Soll 2010
    1. Soll R, Ozek E. Prophylactic protein free synthetic surfactant for preventing morbidity and mortality in preterm infants. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD001079.pub2] - DOI - PMC - PubMed
Stevens 2007
    1. Stevens TP, Harrington EW, Blennow M, Soll RF. Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database of Systematic Reviews 2007, Issue 4. [DOI: 10.1002/14651858.CD003063.pub3; PubMedPMID: 17943779.] - DOI - PMC - PubMed
Vaucher 1993
    1. Vaucher YE, Harker L, Merritt TA, Hallman M, Gist K, Bejar R, et al. Outcome at twelve months of adjusted age in very low birth weight infants with lung immaturity: a randomized, placebo‐controlled trial of human surfactant. Journal of Pediatrics 1993;122:126‐32. - PubMed
Wright 1997
    1. Wright JL, Sun JP, Churg A. Site of methacholine reactivity in the peripheral airways: analysis using lung explants. American Journal of Physiology 1997;272:L68‐72. [PubMed PMID: 9038904] - PubMed

References to other published versions of this review

Soll 2001b
    1. Soll RF, Morley CJ. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database of Systematic Reviews 2001, Issue 2. [DOI: 10.1002/14651858.CD000510; PubMed PMID: 11405966] - DOI - PubMed

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