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Intervention Review

Surfactant for meconium aspiration syndrome in full term/near term infants

  1. Amr I El Shahed1,*,
  2. Peter A. Dargaville2,
  3. Arne Ohlsson3,
  4. Roger Soll4

Editorial Group: Cochrane Neonatal Group

Published Online: 18 JUL 2007

Assessed as up-to-date: 15 MAY 2007

DOI: 10.1002/14651858.CD002054.pub2


How to Cite

El 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. Art. No.: CD002054. DOI: 10.1002/14651858.CD002054.pub2.

Author Information

  1. 1

    Mount Sinai Hospital, Paediatrics, Toronto, Ontario, Canada

  2. 2

    Royal Hobart Hospital, Department of Paediatrics, Hobart, Tasmania, Australia

  3. 3

    University of Toronto, Departments of Paediatrics, Obstetrics and Gynaecology and Health Policy, Management and Evaluation, Warkworh, Ontario, Canada

  4. 4

    University of Vermont, Division of Neonatal-Perinatal Medicine, Burlington, Vermont, USA

*Amr I El Shahed, Paediatrics, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada. amrshahed@yahoo.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 JUL 2007

SEARCH

This is not the most recent version of the article. View current version (14 DEC 2014)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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 term/near-term infants with MAS.

Search methods

Searches were made using 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 hand searching. No language restrictions were applied. Authors were directly contacted to provide additional data.

Selection criteria

Randomised controlled trials which evaluated the effect of surfactant administration in term infants with meconium aspiration syndrome are included in the analyses.

Data collection and analysis

Data regarding 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, and were excerpted from the reports of the clinical trails by the review authors. Data analyses were done in accordance with the standards of the Cochrane Neonatal Review Group.

Main results

Four randomised controlled trials met inclusion criteria. The meta-analysis of 4 trials enrolling 326 infants showed no statistically significant effect on mortality (typical relative risk 0.98 (95% CI 0.41, 2.39), typical risk difference 0.00 (95% CI -0.05, 0.05). The risk of requiring extracorporeal membrane oxygenation was significantly reduced in a meta-analysis of two trials (n = 208); (typical relative risk 0.64, 95% CI 0.46, 0.91; typical risk difference -0.17, 95% CI -0.30, -0.04); number needed to treat to benefit 6 (95% CI 3, 25). One trial (n = 40) reported a statistically significant reduction in the length of hospital stay [mean difference - 8 days (95% CI -14, -3 days)]. 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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Surfactant for meconium aspiration syndrome in full term/near term infants

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 be able to help overcome this damage. This review of trials found that surfactant can reduce breathing difficulties and breathing failure in babies suffering from meconium aspiration syndrome.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

對於足月/接近足月之嬰兒所發生的胎糞吸入症候群(meconium aspiration syndrome; MAS)所使用之表面張力素(Surfactant)

關於表面張力素替代療法能夠有效地預防及治療新生兒呼吸窘迫症候群(RDS),已經獲得了證實。在許多類型的疾病,包括胎糞吸入症候群(MAS),會因為表面張力素不足,或是表面張力素失去功能,而使呼吸衰竭之情形更容易形成。

目標

針對屬於胎糞吸入症候群的足月/接近足月之嬰兒,若是在治療的時候給予表面張力素,要評估這種作法的影響。

搜尋策略

針對屬於胎糞吸入症候群的足月嬰兒,給予他們表面張力素,曾經評估過這種作法的影響隨機對照試驗,就會被收集在分析內容之中。

選擇標準

搜尋 Cochrane Library (Issue 4, 2006)、 EDLINE以及EMBASE (1985年2006年12月)、之前的文獻回顧,包含交互參照文獻、摘要、以及研討會手冊、專家資訊以及人工搜尋期刊。語言不限,並直接聯絡作者以提供額外數據。

資料收集與分析

關於臨床預後方面的資料,包括了死亡率、使用體外膜氧合器(ECMO)的治療、氣胸、輔助式呼吸器使用的時間長度、給予氧氣的時間長度、腦室內出血(任何程度與嚴重的腦室內出血),以及慢性肺部疾病,這些資料都是由審稿的作者從臨床試驗的報告中摘錄出來的。資料的分析工作,都是按照Cochrane Neonatal Review Group的各項標準來進行。

主要結論

共有4份隨機對照試驗符合了收集的標準。在這4份試驗的統合分析當中,共收集了326名嬰兒,對於死亡率而言,並沒有統計學上有意義的影響(典型的相對風險為0.98(95% I 0.41,2.39)),典型的風險差異為0.00(95% I −0.05,0.05)。在由2份試驗所得到的統合分析之中顯示,需要使用到體外膜氧合器的風險,明顯地下降(樣本數 208);(典型的相對風險為0.64,95% I 0.46,0.91;典型的風險差異為−0.17,95% I −0.30,−0.04 – 0.17,95% CI −0.30,−0.04);因這種治療方式而有一個病人會得到好處所需要治療之病人的數目為6(95% I 3,25)。有1份試驗(樣本數 40)報告住院的時間長度統計學上有意義地縮短【平均差異為 天(95% CI −14,−3天)】。在其他的預後(輔助式呼吸器使用的時間長度、給予氧氣的時間長度、氣胸、肺間質性肺氣腫、氣漏、慢性肺部疾病、出院時仍需要使用氧氣,或是腦室內出血)當中,都沒有發現到統計學上有什麼顯著的差異。

作者結論

在有胎糞吸入症候群的嬰兒們身上,給予表面張力素或許可以降低呼吸疾病的嚴重性,也可能會減少因惡化至呼吸衰竭而需要使用體外膜氧合器的機會。跟其他的治療方法比較起來(包括使用一氧化氮、液態式呼吸、表面張力素灌洗,以及高頻呼吸等等),或是跟這些方法合併使用的方式,使用表面張力素療法的相對功效還必須要再接受測試。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

胎糞吸入症候群會對新生嬰兒的肺部造成傷害。胎糞吸入症候群是因為在子宮裡感到不適的嬰兒排便後又將這些糞便吸入了肺部所導致的。表面張力素是很多種化學物質所形成的複雜組成,且存在於肺部的表面,在吸入胎糞的嬰兒體內,表面張力素可能會發生改變,或是失去功能。人們認為,額外添加表面張力素來進行治療時,或許能夠用來幫助克服這樣的傷害。本篇試驗的回顧發現,對於胎糞吸入症候群的嬰兒來說,表面張力素可以減少呼吸困難及呼吸衰竭之情況。