Surfactant for meconium aspiration syndrome in term and late preterm infants

Lay title: Surfactant treatment for infants who have inhaled meconium into the lungs in or around the time of birth

Review question: Does the administration of surfactant improve lung function and lead to better clinical outcomes in infants born at or near term who have inhaled meconium in or around the time of birth?

Background: The lungs of newborn babies can be damaged by meconium aspiration syndrome. Meconium aspiration syndrome is caused when a stressed baby passes a bowel movement while still in the womb and then breathes some of this material into the lungs. Pulmonary surfactant, the complex combination of chemicals that line the surface of the lung, may be altered or inactivated in babies who have meconium aspiration. It is thought that treatment with additional surfactant might help overcome this damage.

Study characteristics: Four randomised controlled trials enrolling 326 infants met our inclusion criteria.

Results: This review of trials found that surfactant can prevent worsening of breathing difficulties and reduce the need for heart-lung bypass therapy in some babies suffering from meconium aspiration syndrome .

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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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 strategy: 

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).

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