Prophylactic animal derived surfactant extract for preventing morbidity and mortality in preterm infants
- 20 October 1997
- journal article
- review article
- Published by Wiley in Cochrane Database of Systematic Reviews
- Vol. 1997 (2), CD000511
- https://doi.org/10.1002/14651858.cd000511
Abstract
This section is under preparation and will be included in the next issue. To assess the effect of prophylactic intratracheal administration of natural surfactant extract in preterm newborns at risk for developing respiratory distress syndrome (RDS). Searches were made of the Oxford Database of Perinatal Trials, Medline (MeSH terms: pulmonary surfactant; limits: age groups; newborn infants), previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants and journal hand searching in the English language. Randomized controlled trials which compared the effect of prophylactic natural surfactant administration (surfactant obtained from human or bovine sources, either modified with additional phospholipids or not) administered to high risk preterm newborns at or shortly after birth in order to prevent respiratory distress syndrome, other complications of prematurity, and mortality. Data regarding clinical outcomes including incidence of pneumothorax, pulmonary interstitial emphysema, patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage (any grade and severe intraventricular hemorrhage), bronchopulmonary dysplasia, mortality, bronchopulmonary dysplasia or death, and retinopathy of prematurity were excerpted from the reports of the clinical trials by the reviewer. Data analysis was done in accordance with the standards of the Cochrane Neonatal Review Group. All of the included studies note an initial improvement in respiratory status and a decrease in the risk of respiratory distress syndrome in infants who receive prophylactic natural surfactant extract. The meta-analysis supports a decrease in the risk of pneumothorax (typical relative risk 0.35, 95% CI 0.26, 0.49; typical risk difference -0.15, 95% CI -0.20, -0.11), a decrease in the risk pulmonary interstitial emphysema (typical relative risk 0.46, 95% CI 0.35, 0.60; typical risk difference -0.19, 95% CI -0.25, -0.13), a decrease in the risk of neonatal mortality (typical relative risk 0. 60, 95% CI 0.44, 0.83; typical risk difference -0.07, 95% CI -0.12, -0.03), and a decrease in the risk of bronchopulmonary dysplasia or death (typical relative risk 0.84, 95% CI 0.75, 0.93; typical risk difference -0.10, 95% CI -0.16, -0.04. No differences are reported in the risk of intraventricular hemorrhage, patent ductus arteriosus, necrotizing enterocolitis or retinopathy of prematurity. Few data are available on long-term followup of treated infants. Prophylactic intratracheal administration of natural surfactant extract to infants judged to be at risk of developing respiratory distress syndrome (intubated infants <30 weeks gestation) has been demonstrated to improve clinical outcome. Infants who receive prophylactic natural surfactant extract 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.Keywords
This publication has 16 references indexed in Scilit:
- Prophylactic protein free synthetic surfactant for preventing morbidity and mortality in preterm infantsCochrane Database of Systematic Reviews, 2010
- Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infantsPublished by Wiley ,2001
- Prophylactic animal derived surfactant extract for preventing morbidity and mortality in preterm infantsCochrane Database of Systematic Reviews, 1997
- Prophylaxis of respiratory distress syndrome by treatment with modified porcine surfactant at birth: a multicentre prospective randomized trialjpme, 1996
- Pulmonary hemorrhage and exogenous surfactant therapy: A metaanalysisThe Journal of Pediatrics, 1993
- Surfactant replacement therapy at birth: final analysis of a clinical trial and comparisons with similar trials.1988
- Prophylactic Treatment of Very Premature Infants with Human SurfactantNew England Journal of Medicine, 1986
- Double-Blind Clinical Trial of Calf Lung Surfactant Extract for the Prevention of Hyaline Membrane Disease in Extremely Premature InfantsPEDIATRICS, 1985
- Surfactant and pulmonary blood flow distributions following treatment of premature lambs with natural surfactant.JCI Insight, 1984
- Lung Surfactant and the Pathogenesis of Neonatal Bronchiolar Lesions Induced by Artificial VentilationPediatric Research, 1978