Surfactant for meconium aspiration syndrome in term and late preterm infants

A nurse cares for an infant in the neonatal intensive care unit of a Paediatric Hospital in Gaza Strip.
UNICEF/El Baba

Surfactant for meconium aspiration syndrome in term and late preterm infants

Key findings

  • Administering intratracheal surfactant to term and late preterm infants with meconium aspiration syndrome (MAS) reduces their likelihood of requiring extra-corporeal membrane oxygenation (ECMO) and reduces their duration of hospital stay.
  • Surfactant did not appear to impact infant mortality or other endpoints of the included studies.
  • The efficacy of surfactant compared to other treatments remains unclear.

Evidence included in this review

Four trials including a total of 326 late preterm and term infants with MAS were included in this review. Infants received intratracheal surfactant versus placebo/no therapy. Trials were from China, USA (2) and Chile.

Quality assessment

All studies were at low risk of bias except for one, which failed to blind participants, personnel or outcomes assessors. The GRADE quality of the evidence was not applied.

Clinical implications

Surfactant administration did not affect infant mortality. It reduced the duration of hospital stay by 8 days, and reduced treatment with ECMO. Administering surfactant did not have a statistically significant effect on the occurrence of pneumothorax, pulmonary interstitial emphysema, air leaks, supplemental oxygen requirements at discharge, or intraventricular haemorrhage. Nor was there an effect on the duration of mechanical ventilation or supplemental oxygen required.

 

Further research

The optimal therapy for meconium aspiration syndrome remains unclear, and further research is required to investigate the relative efficacy of different treatments, ways of administration and different treatments combinations.


Cochrane review

Citation: El Shahed AI, Dargaville PA , Ohlsson A, Soll R. Surfactant for meconium aspiration syndrome in term and late preterm infants. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD002054. DOI: 10.1002/14651858.CD002054.pub3.

Abstract

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).

To evaluate the effect of surfactant administration in the treatment of late preterm and term infants with meconium aspiration syndrome.

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.

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.

 

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.

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).

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.