Efficacy of pulmonary surfactant therapy in neonates with meconium aspiration syndrome: a meta-analysis

LUO Fei-Fei; YANG Di-Yuan; CHEN Pan; HUA Zi-Yu

PDF(939 KB)

Chinese Journal of Contemporary Pediatrics ›› 2012, Vol. 14 ›› Issue (06) : 413-417.

Efficacy of pulmonary surfactant therapy in neonates with meconium aspiration syndrome: a meta-analysis

LUO Fei-Fei, YANG Di-Yuan, CHEN Pan, HUA Zi-Yu

Author information +

History +

Abstract

OBJECTIVE: The efficacy of pulmonary surfactant (PS) replacement therapy for meconium aspiration syndrome (MAS) remains controversial. This study aimed to evaluate the efficacy of PS therapy in neonates with MAS by a meta-analysis. METHODS: Randomized controlled trials (RCTs) on the treatment of MAS with PS were searched electronically in medical debases including PubMed, Science Citation Index, The Cochrane Central Register of Controlled Trials, Ovid, EBSCOhost, BIOSIS previews, Chinese BioMedical Literature Database, Wanfang Database and VIP Chinese Sci-Tech Periodical Database. The Cochrane Handbook 5.0.2 was employed to evaluate methodological quality. RevMan 5.0.25 software was used for the meta-analysis. RESULTS: Eight RCTs including 512 MAS neonates (257 cases in the PS treatment group and 255 cases in the control group) were enrolled in this meta-analysis. The meta-analysis showed that PS treatment reduced oxygenation index (MD=-2.59; 95%CI: -4.33, -0.86; P=0.003), increased arterial oxygen/alveolar oxygen ratio (MD=0.05; 95%CI: 0.05, 0.06; P<0.00001), shortened hospitalization days (MD=-4.94; 95%CI: -7.44, -2.44; P=0.0001) and decreased mortality rate (OR=0.47; 95%CI: 0.24, 0.93; P=0.03) significantly. There were no statistical differences in the durations of mechanical ventilation and oxygen therapy, and the incidences of air leak, pulmonary hemorrhage and intracranial hemorrhage between the PS treatment and control groups. CONCLUSIONS: Currently published evidence from RCTs suggests that PS replacement therapy is effective for MAS, however because of the limited quantity and quality of trials enrolled in the study, further evidence from RCTs is needed to prove the efficacy.

Key words

Pulmonary surfactant / Meconium aspiration syndrome / Efficacy / Meta-analysis / Neonate

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

LUO Fei-Fei, YANG Di-Yuan, CHEN Pan, HUA Zi-Yu. Efficacy of pulmonary surfactant therapy in neonates with meconium aspiration syndrome: a meta-analysis[J]. Chinese Journal of Contemporary Pediatrics. 2012, 14(06): 413-417

References

［1］Qian L, Liu C, Zhuang W, Guo Y, Yu J, Chen H, et al. Neonatal respiratory failure: a 12-month clinical epidemiologic study from 2004 to 2005 in China ［J］. Pediatrics, 2008, 121 (5): e1115-e1124.

［2］Bhat RY, Rao A. Meconium-stained amniotic fluid and meconium aspiration syndrome: a prospective study［J］. Ann Trop Paediatr, 2008, 28(3): 199-203.

［3］杨迪元，华子瑜. 糖皮质激素治疗胎粪吸入综合征的研究进展［J］. 中国当代儿科杂志, 2010, 12 (6): 505-508.

［4］El Shahed AI, Dargaville P, Ohlsson A, Soll R. Surfactant for meconium aspiration syndrome in full term/near term infants［J/OL］. Cochrane Database Syst Rev, 2007, (3): CD002054.

［5］章丽星. 肺表面活性物质治疗重症胎粪吸入综合征的疗效［J］. 实用儿科临床杂志, 2007, 22(4): 302-303.

［6］黄婉英. 早期应用肺表面活性物质联合持续正压通气在基层医院新生儿胎粪吸入综合征中的应用价值［J］. 广东医学, 2009, 30(7): 1151-1153.

［7］常志霞，刘翠青，马海燕，刘素哲，李莉，邱向利. 外源性肺表面活性物质对胎粪吸入综合征肺表面活性物质相关蛋白的影响［J］. 中国新生儿科杂志, 2009, 24(5): 273-276.

［8］Findlay RD, Taeusch HW, Walther FJ. Surfactant replacement therapy for meconium aspiration syndrome［J］. Pediatrics, 1996, 97(1): 48-52.

［9］Dargaville PA, Mills JF, Copnell B, Loughnan PM, McDougall PN, Morley CJ. Therapeutic lung lavage in meconium aspiration syndrome: a preliminary report［J］. J Paediatr Child Health, 2007, 43(7-8): 539-545.

［10］常立文. 新生儿颅内出血［M］ // 沈晓明，王卫平.儿科学.第7版. 北京: 人民卫生出版社, 2008: 105-107.

［11］Higgins JPT, Green S(editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 ［DB/OL］. The Cochrane Collaboration, 2009.［updated March 2011］. http://www.cochrane-handbook.org.

［12］Chinese Collaborative Study Group for Neonatal Respiratory Diseases (Sun Bo). Treatment of severe meconium aspiration syndrome with porcine surfactant: a multicentre, randomized, controlled trial［J］. Acta Pediatrica, 2005, 94(7): 896-902.

［13］Wiswell TE, Knight GR, Finer NN, Donn SM, Desai H,Walsh WF, et al. A multicenter, randomized, controlled trial comparing surfaxin (Lucinactant) lavage with standard care for treatment of meconium aspiration syndrome［J］. Pediatrics, 2002, 109(6): 1081-1087.

［14］Dargaville PA, Copnell B, Mills JF, Haron I, Lee JK, Tingay DG, et al. Randomized controlled trial of lung lavage with dilute surfactant for meconium aspiration syndrome［J］. J Pediatr, 2010, 158(3): 383-389.

［15］Lotze A, Mitchell BR, Bulas DI, Zola EM, Shalwitz RA, Gunkel JH, et al. Multicenter study of surfactant (beractant) use in the treatment of term infants with severe respiratory failure［J］. J Paediatr, 1998, 132(1): 40-47.

［16］Maturana A, Torres-Pereyra J, Salinas R, Astudillo P, Moya FR. A randomized trial of natural surfactant for moderate to severe meconium aspiration syndrome［J/OL］. PAS， 2005, 57: 1545.

［17］叶贞志，李月凤，卢光进，韩玉昆. 外源性肺表面活性物质治疗新生儿呼吸窘迫综合征的疗效分析［J］.广东医学, 2005, 26(7): 889-891.

［18］Soll RF, Morley CJ. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants［J］. Cochrane Database Syst Rev, 2001(2): CD000510.

［19］Sweet DG, Halliday HL. The use of surfactants in 2009［J］. Arch Dis Child Educ Pract Ed, 2009, 94(3): 78-83.

［20］李禄全，余加林，陈静宇，张先红，袁晓丽. 牛肺表面活性物质治疗早产儿呼吸窘迫综合征对脑血流动力学的影响［J］.第三军医大学学报, 2010, 32(21): 2333-2335.

［21］杨杰，李文成，叶秀桢，高薇薇，聂川. 首剂大剂量肺表面活性物质治疗重度新生儿肺透明膜病临床观察［J］.中国实用儿科杂志, 2009, 24(1): 50-52.

［22］Jeng MJ, Soong WJ, Lee YS. Effective lavage volume of diluted surfactant improves the outcome of meconium aspiration syndrome in newborn piglets［J］. Pediatr Res, 2009, 66(1): 107-112.

［23］Kinsella JP. Meconium aspiration syndrome: is surfactant lavage the answer?［J］. Am J Respir Crit Care Med, 2003, 168(4): 413-414.