Intra-amniotic surfactant for women at risk of preterm birth for preventing respiratory distress in newborns.
BACKGROUND
Early surfactant reduces mortality and pulmonary complications in preterm infants with respiratory distress syndrome. However, current surfactant administration strategies require endotracheal intubation with or without continued mechanical ventilation. Bronchopulmonary dysplasia and chronic lung disease (CLD) are associated with mechanical ventilation and potentially life-long effects. Non-invasive methods of surfactant administration including intra-amniotic surfactant may avoid endotracheal intubation and mechanical ventilation, potentially preventing development of CLD.


OBJECTIVE
To determine if intra-amniotic instillation of surfactant for women at risk of preterm birth, compared to placebo or no treatment or post-delivery tracheal surfactant instillation, reduces morbidity or mortality, or both, in preterm infants. If intra-amniotic instillation is effective, in subgroup analysis to determine the effect of 1) gestational age; 2) type of surfactant; 3) dose; 4) timing; 5) indication; and 6) multiple pregnancy.


METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (August 2009), MEDLINE (1950-August 2009), handsearched the Proceedings of Pediatric Academic Societies (American Pediatric Society, Society for Pediatric Research and European Society for Pediatric Research) from 1990-2009 in Pediatric Research Journal and Abstracts online and the Proceedings of Perinatal Society of Australia and New Zealand (PSANZ) (1996-2009). We also searched the Science Citation Index (Web of Science) (August 2009) and checked reference lists of identified studies. We contacted Abbott Laboratories, Inc for unpublished studies.


METHODS
Published, unpublished and ongoing randomised controlled, cluster-randomised or quasi-randomised trials of intra-amniotic instillation of surfactant for women at risk of preterm birth, compared to placebo or no treatment or post-delivery tracheal surfactant instillation.


METHODS
Three review authors independently assessed study eligibility and quality.


RESULTS
We found no trials were found met the inclusion criteria for this review.


CONCLUSIONS
We identified no randomised trials that evaluated the effect of intra-amniotic instillation of surfactant for women at risk of preterm birth. Evidence from animal and observational human studies suggest that intra-amniotic surfactant administration is potentially safe, feasible and effective. Well designed trials of intra-amniotic instillation of surfactant for women at risk of preterm birth are needed.
Abdel-Latif
Mohamed E
ME
Department of Neonatology, The Canberra Hospital, Building 11, Level 3, Yamba Drive, Garran, Australian Capital Territory, Australia, 2605.
Osborn
David A
DA
Challis
Daniel
D
D000650:Amnion; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007267:Injections / Q000379:methods; D011247:Pregnancy; D047928:Premature Birth; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control*
D011663:Pulmonary Surfactants