title: Effect of exogenous pulmonary surfactants on mortality rate in neonatal respiratory distress syndrome: A network meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  The utilization of multiple natural and synthetic products in surfactant replacement therapies in treatment of neonatal respiratory distress syndrome (NRDS) prompted us to take a closer looks at these various therapeutic options and their efficacies. The purpose of our study was to evaluate the effects of six exogenous pulmonary surfactants (EPS) (Survanta, Alveofact, Infasurf, Curosurf, Surfaxin and Exosurf) on mortality rate in NRDS by a network meta-analysis.
  
  
  METHODS
  An exhaustive search of electronic databases was performed in PubMed, Ovid, EBSCO, Springerlink, Wiley, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang and VIP databases (last updated search in October 2014) to retrieve randomized controlled trials (RCTs) relevant to our study topic. Published clinical trials were screened based on the following inclusion criteria: (1) study design: RCTs; (2) interventions: treatment with Survanta, Alveofact, Infasurf, Curosurf, Surfaxin or Exosurf for NRDS; (3) study subject: infants with NRDS confirmed by clinical diagnosis; (4) outcome: the mortality rate of infants with NRDS. Statistical analysis was performed using Stata 12.0 software (Stata Corporation, College Station, TX, USA) and Comprehensive Meta-analysis (CMA 2.0) software.
  
  
  RESULTS
  From the 1840 studies initially retrieved through database searches, a total of 17 high quality RCTs were selected for this network meta-analysis. The selected studies included a combined total of 57,223 infants with NRDS treated with various EPS (Survanta, 27,017; Alveofact, 159; Infasurf, 20,377; Curosurf, 20,911; Surfaxin, 646; Exosurf, 1640). Network meta-analysis results showed that the mortality rates in NRDS infants treated with Alveofact, Infasurf, Curosurf, Surfaxin, Exosurf were not significantly different compared to Survanta (Alveofact: OR = 1.163, 95% CI = 0.645-2.099, P = 0.616; Infasurf: OR = 0.985, 95% CI = 0.777-1.248, P = 0.897; Curosurf: OR = 0.789, 95% CI = 0.619-1.007, P = 0.056; Surfaxin: OR = 0.728, 95% CI = 0.477-1.112, P = 0.142; Exosurf: OR = 0.960, 95% CI = 0.698-1.319, P = 0.799). Notably, the surface under the cumulative ranking curves (SUCRA) value in Surfaxin group was significantly higher than the other five groups (Surfaxin: 80.4%; Survanta: 37.0%; Alveofact: 24.4%; Infasurf: 40.0%; Curosurf: 73.9%; Exosurf: 44.2%), suggesting that infant mortality rate in Surfaxin group was the lowest among the six EPS groups.
  
  
  CONCLUSIONS
  Our study demonstrated that Surfaxin could effectively reduce the mortality rate of infants with NRDS and may have a better efficacy in NRDS treatment, compared to Survanta, Alveofact, Infasurf, Curosurf and Exosurf.
authors: Department of Neonatology, The First Affiliated Hospital of China Medical University, No. 155 Nan Jing Northern Street, Shenyang 110001, PR China.
authors: Liang
authors: L
authors: Zhang
authors: Department of Pathology, The First Affiliate Hospital and College of Basic Medicine, China Medical University, No. 155 Nan Jing Northern Street, Shenyang 110001, PR China.
authors: Hong-Yi
authors: HY
authors: Cao
authors: Department of Pediatrics, The Fourth People Hospital of Shenyang, No. 20 Huang He Street, Shenyang, Liaoning 110003, PR China.
authors: Shuang
authors: S
authors: Zhao
authors: Department of Biochemistry and Molecular Biology, Harbin Medical University Daqing Campus, Daqing 163319, PR China.
authors: Li-Jie
authors: LJ
authors: Yuan
authors: Department of Neonatology, The First Affiliated Hospital of China Medical University, No. 155 Nan Jing Northern Street, Shenyang 110001, PR China.
authors: Dan
authors: D
authors: Han
authors: Department of Pediatrics, The First Affiliated Hospital of China Medical University, 155 Nan Jing Northern Street, Shenyang 110001, PR China.
authors: Hong
authors: H
authors: Jiang
authors: Department of Pediatrics, The Fourth People Hospital of Shenyang, No. 20 Huang He Street, Shenyang, Liaoning 110003, PR China.
authors: Song
authors: S
authors: Wu
authors: Department of Neonatology, The First Affiliated Hospital of China Medical University, No. 155 Nan Jing Northern Street, Shenyang 110001, PR China. Electronic address: HM_WU@Hotmail.com.
authors: Hong-Min
authors: HM
authors: Wu
mesh_terms: D001688:Biological Products / Q000627:therapeutic use; D004338:Drug Combinations; D005233:Fatty Alcohols / Q000627:therapeutic use; D006801:Humans; D010715:Phosphatidylglycerols / Q000627:therapeutic use; D010743:Phospholipids / Q000627:therapeutic use; D010767:Phosphorylcholine / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011506:Proteins / Q000627:therapeutic use; D011663:Pulmonary Surfactants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy*
chemical_list: D001688:Biological Products; D004338:Drug Combinations; D005233:Fatty Alcohols; D010715:Phosphatidylglycerols; D010743:Phospholipids; D011506:Proteins; D011663:Pulmonary Surfactants; C078272:SF-RI 1, bovine surfactant preparation; C502722:lucinactant; D010767:Phosphorylcholine; D011092:Polyethylene Glycols; C047049:dipalmitoylphosphatidylcholine, hexadecanol, tyloxapol drug combination; C068291:poractant alfa; C117342:calfactant; C072197:beractant
keywords: Exogenous pulmonary surfactant; Neonatal respiratory distress syndrome; Network meta-analysis; Randomized controlled trials