Respiratory distress syndrome (RDS) is caused by a deficiency or dysfunction of pulmonary surfactant. A wide variety of surfactant products have been formulated and studied in clinical trials. These include synthetic surfactants and animal derived surfactant extracts. Trials of surfactant replacement have either tried to prevent the development of respiratory distress in high-risk premature infants or treat established respiratory distress in premature infants.
To assess the effect of administration of animal derived surfactant extract on mortality, chronic lung disease and other morbidities associated with prematurity in preterm infants with established respiratory distress syndrome. Subgroup analysis were planned according to the specific surfactant product, the degree of prematurity, and the severity of disease.
Searches were made of the Oxford Database of Perinatal Trials, MEDLINE, EMBASE, and CINAHL from 1975 through December 2008. In addition, searches were made of previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants and journal hand searching in the English language.
Randomized or quazi-randomized controlled trials that compared the effect of animal derived surfactant extract treatment administered to infants with established respiratory distress syndrome in order to prevent complications of prematurity and mortality.
Data collection and analysis
Data regarding clinical outcomes were excerpted from the reports of the clinical trials by the review authors. Data analysis was done in accordance with the standards of the Cochrane Neonatal Review Group.
Thirteen randomized controlled trials were included in the analysis. The studies demonstrated an initial improvement in respiratory status (improved oxygenation and decreased need for ventilator support). The meta-analysis supports a significant decrease in the risk of any air leak (typical relative risk 0.47, 95% CI 0.39, 0.58; typical risk difference -0.16, 95% CI -0.21, -0.12), pneumothorax (typical relative risk 0.42, 95% CI 0.34, 0.52; typical risk difference -0.17, 95% CI -0.21, -0.13), and a significant decrease in the risk of pulmonary interstitial emphysema (typical relative risk 0.45, 95% CI 0.37, 0.55; typical risk difference -0.20, 95% CI -0.25, -0.15). There is a significant decrease in the risk of neonatal mortality (typical relative risk 0.68, 95% CI 0.57, 0.82; typical risk difference -0.09, 95% CI -0.13, -0.05), a significant decrease in the risk of mortality prior to hospital discharge (typical relative risk 0.63, 95% CI 0.44, 0.90; typical risk difference -0.10, 95% CI -0.18, -0.03) and a significant decrease in the risk of bronchopulmonary dysplasia (BPD) or death at 28 days of age (typical relative risk 0.83, 95% CI 0.77, 0.90; typical risk difference -0.11, 95 CI -0.16, -0.06). No differences are reported in the risk of patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, BPD or retinopathy of prematurity.
Infants with established respiratory distress syndrome who receive animal derived surfactant extract treatment 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.
我們搜索自1975至2008年12月Oxford Database of Perinatal Trials, MEDLINE, EMBASE,與CINAHL。另外我們也搜尋 先前回顧 (包括交叉引用參考文獻、摘要、會議與學術討論會會報)，專家報導與手工搜尋英文期刊。
關於臨床結果的數據被作者從臨床試驗報告中節錄，並依據Cochrane Neonatal Review Group的標準分析數據。
共納入13個隨機對照試驗。它們顯示對呼吸狀態初期有改善(氧合能力和減少呼吸器需求)。統合分析顯示下列結果都顯著風險降低：任何氣體滲漏(典型相對風險0.47, 95%信賴區間 0.39, 0.58;典型風險差 −0.16, 95% CI −0.21, −0.12)，氣胸(典型相對風險0.42, 95%信賴區間0.34, 0.52; 典型風險差−0.17, 95%信賴區間−0.21, −0.13)，肺間質氣腫(典型相對風險0.45, 95%信賴區間0.37, 0.55; 典型風險差−0.20, 95%信賴區間−0.25, −0.15)，新生兒死亡率(典型相對風險0.68, 95%信賴區間0.57, 0.82; 典型風險差−0.09, 95%信賴區間−0.13, −0.05)，出院後死亡(典型相對風險0.63, 95%信賴區間0.44, 0.90; 典型風險差−0.10, 95%信賴區間−0.18, −0.03)，28天死亡率(典型相對風險0.83, 95%信賴區間0.77, 0.90; 典型風險差−0.11, 95信賴區間 −0.16, −0.06)。以下是沒有顯著差異的：動脈導管未閉、壞死性腸炎、腦室內出血、肺支氣管生長不全或早產兒視網膜病變。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。