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Meta-Analysis
. 2014 Dec 14;2014(12):CD002054.
doi: 10.1002/14651858.CD002054.pub3.

Surfactant for meconium aspiration syndrome in term and late preterm infants

Amr I El Shahed  1 , Peter A Dargaville, Arne Ohlsson, Roger Soll
Affiliations
Meta-Analysis

Surfactant for meconium aspiration syndrome in term and late preterm infants

Amr I El Shahed et al. Cochrane Database Syst Rev. .

Abstract

Background: Surfactant replacement therapy has been proven beneficial in the prevention and treatment of neonatal respiratory distress syndrome (RDS). The deficiency of surfactant or surfactant dysfunction may contribute to respiratory failure in a broader group of disorders, including meconium aspiration syndrome (MAS).

Objectives: To evaluate the effect of surfactant administration in the treatment of late preterm and term infants with meconium aspiration syndrome.

Search methods: We searched The Cochrane Library (Issue 4, 2006), MEDLINE and EMBASE (1985 to December 2006), previous reviews including cross-references, abstracts, conference and symposia proceedings, expert informants, and journal handsearching, without language restrictions. We contacted study authors for additional data.We ran an updated search in November 2014 and searched the following sites for ongoing or recently completed trials: www.clinicaltrials.gov; www.controlled-trials.com; and www.who.int/ictrp.

Selection criteria: Randomised controlled trials which evaluated the effect of surfactant administration in late preterm and term infants with meconium aspiration syndrome are included in the analyses.

Data collection and analysis: We extracted data on clinical outcomes including mortality, treatment with extracorporeal membrane oxygenation (ECMO), pneumothorax, duration of assisted ventilation, duration of supplemental oxygen, intraventricular haemorrhage (any grade and severe IVH), and chronic lung disease. We conducted data analyses in accordance with the standards of the Cochrane Neonatal Review Group.

Main results: Four randomised controlled trials met our inclusion criteria. The meta-analysis of four trials (326 infants) showed no statistically significant effect on mortality [typical risk ratio (RR) 0.98, 95% confidence interval (CI) 0.41 to 2.39; typical risk difference (RD) -0.00, 95% CI -0.05 to 0.05]. There was no heterogeneity for this outcome (I² = 0% for both RR and RD). The risk of requiring extracorporeal membrane oxygenation was significantly reduced in a meta-analysis of two trials (n = 208); [typical RR 0.64, 95% CI 0.46 to 0.91; typical RD -0.17, 95% CI -0.30 to -0.04; number needed to treat for an additional beneficial outcome (NNTB) 6, 95% CI 3 to 25]. There was no heterogeneity for RR (1² = 0%) but moderate heterogeneity for RD (I² = 50%). One trial (n = 40) reported a statistically significant reduction in the length of hospital stay (mean difference -8 days, 95% CI -14 to -3 days; test for heterogeneity not applicable). There were no statistically significant reductions in any other outcomes studied (duration of assisted ventilation, duration of supplemental oxygen, pneumothorax, pulmonary interstitial emphysema, air leaks, chronic lung disease, need for oxygen at discharge or intraventricular haemorrhage).

Authors' conclusions: In infants with MAS, surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO. The relative efficacy of surfactant therapy compared to, or in conjunction with, other approaches to treatment including inhaled nitric oxide, liquid ventilation, surfactant lavage and high frequency ventilation remains to be tested.

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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 or distribute surfactant preparations (Abbott Laboratories, Ross Laboratories, Chiesi Pharmaceuticals, Dey Laboratories, Burroughs Wellcome) but has not done so for over 6 years. Dr P. Dargaville has received support for basic science research in surfactant lavage studies from Abbott Australasia. Neither Dr El Shahed nor Dr Ohlsson have conflicts of interest to disclose.

Figures

1.1
1.1. Analysis
Comparison 1 Surfactant therapy vs. placebo or no therapy in term/near‐term infants, Outcome 1 Mortality.
1.2
1.2. Analysis
Comparison 1 Surfactant therapy vs. placebo or no therapy in term/near‐term infants, Outcome 2 Treatment with ECMO.
1.3
1.3. Analysis
Comparison 1 Surfactant therapy vs. placebo or no therapy in term/near‐term infants, Outcome 3 Pneumothorax.
1.4
1.4. Analysis
Comparison 1 Surfactant therapy vs. placebo or no therapy in term/near‐term infants, Outcome 4 Pulmonary interstitial emphysema.
1.5
1.5. Analysis
Comparison 1 Surfactant therapy vs. placebo or no therapy in term/near‐term infants, Outcome 5 Air leaks (pneumothorax, pneumomediastinum, interstitial emphysema).
1.6
1.6. Analysis
Comparison 1 Surfactant therapy vs. placebo or no therapy in term/near‐term infants, Outcome 6 Duration of assisted mechanical ventilation (days).
1.7
1.7. Analysis
Comparison 1 Surfactant therapy vs. placebo or no therapy in term/near‐term infants, Outcome 7 Duration of supplemental oxygen (days).
1.8
1.8. Analysis
Comparison 1 Surfactant therapy vs. placebo or no therapy in term/near‐term infants, Outcome 8 Need for supplemental oxygen at discharge.
1.9
1.9. Analysis
Comparison 1 Surfactant therapy vs. placebo or no therapy in term/near‐term infants, Outcome 9 Chronic lung disease (age at diagnosis not stated).
1.10
1.10. Analysis
Comparison 1 Surfactant therapy vs. placebo or no therapy in term/near‐term infants, Outcome 10 Intraventricular haemorrhage (any grade).
1.11
1.11. Analysis
Comparison 1 Surfactant therapy vs. placebo or no therapy in term/near‐term infants, Outcome 11 Severe intraventricular haemorrhage.
1.12
1.12. Analysis
Comparison 1 Surfactant therapy vs. placebo or no therapy in term/near‐term infants, Outcome 12 Duration of hospital stay (days).
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Update of

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References to other published versions of this review

El Shahed 2007
    1. Shahed AI, Dargaville PA, Ohlsson A, Soll R. Surfactant for meconium aspiration syndrome in full term/near term infants. Cochrane Database of Systematic Reviews 2007, Issue 3. [DOI: 10.1002/14651858.CD002054.pub2] - DOI - PubMed
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