Surfactant therapy and antibiotics in neonates with meconium aspiration syndrome: a systematic review and meta-analysis.
Meconium aspiration syndrome (MAS), a common cause of respiratory failure in neonates, is associated with high mortality and morbidity. The objectives of this review were to evaluate the effects of administration of (a) surfactant-either as lung lavage (SLL) or bolus surfactant (BS) and (b) antibiotics on mortality and severe morbidities in neonates with MAS. We searched the following databases: MEDLINE via PubMed, Cochrane CENTRAL, WHOLIS and CABI using sensitive search strategies. We included eight studies on use of surfactant and three studies on use of antibiotics. Neither SLL nor BS reduced the risk of mortality in neonates with MAS (relative risk (RR) 0.38, 95% confidence interval (CI) 0.09 to 1.57; and RR 0.80, 95% CI 0.39 to 1.66, respectively). Both SLL and BS reduced the duration of hospital stay (mean difference -2.0, 95% CI -3.66 to -0.34; and RR -4.68, 95% CI -7.11 to -2.24 days, respectively) and duration of mechanical ventilation (mean difference -1.31, 95% CI -1.91 to -0.72; and mean difference 5.4, 95% CI -9.76 to -1.03 days). Neonates who received BS needed extracorporeal membrane oxygenation (ECMO) less often than the controls (RR 0.64, 95% CI 0.46 to 0.91). Use of antibiotics for MAS did not result in significant reduction in the risk of mortality, sepsis or duration of hospital stay. Surfactant administration either as SLL or BS for MAS was found to reduce the duration of mechanical ventilation and hospital stay; BS also reduced the need for ECMO. Administration of antibiotics did not show any significant clinical benefits in neonates with MAS and no evidence of sepsis. Given the limited number of studies and small number of neonates enrolled, there is an urgent need to generate more evidence on the efficacy and cost-effectiveness of these two treatment modalities before recommending them in routine clinical practice.
Newborn Health Knowledge Centre (NHKC), ICMR Center for Advanced Research in Newborn Health, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
C K
CK
Natarajan
Newborn Health Knowledge Centre (NHKC), ICMR Center for Advanced Research in Newborn Health, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
M J
MJ
Sankar
Newborn Health Knowledge Centre (NHKC), ICMR Center for Advanced Research in Newborn Health, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
K
K
Jain
Newborn Health Knowledge Centre (NHKC), ICMR Center for Advanced Research in Newborn Health, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
R
R
Agarwal
Newborn Health Knowledge Centre (NHKC), ICMR Center for Advanced Research in Newborn Health, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
V K
VK
Paul
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008471:Meconium Aspiration Syndrome / Q000188:drug therapy* / Q000401:mortality; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D011663:Pulmonary Surfactants