Prophylactic animal derived surfactant extract for preventing morbidity and mortality in preterm infants

Background Respiratory distress syndrome (RDS) is caused by a deficiency or dysfunction of pulmonary surfactant. A variety of animal derived surfactant extracts have been formulated and given to infants at risk of developing RDS. Objectives To assess the effect of prophylactic intratracheal administration of animal derived surfactant extract on mortality, bronchopulmonary dysplasia (BPD) and other morbidities in preterm newborns at risk for developing RDS. Subgroup analysis were planned according to the specific surfactant product and the degree of prematurity. Search methods Searches were made of MEDLINE and the Cochrane Central Register of Controlled Trials through January 2010. Selection criteria Randomized or quasi‐randomized controlled trials that compared the effect of prophylactic animal derived surfactant extract administration (surfactant obtained from human, porcine or bovine sources, either modified with additional phospholipids or not) administered to high risk preterm newborns at or shortly after birth in order to prevent RDS, mortality and other complications of prematurity. Data collection and analysis Data extraction and analysis was done in accordance with the standards of the CNRG. Main results All nine of the included studies note an initial improvement in respiratory status and a decrease in the risk of RDS in infants who receive prophylactic animal derived surfactant extract. The meta‐analysis supports a decrease in the risk of pneumothorax (typical relative risk 0.40, 95% CI 0.29, 0.54; typical risk difference ‐0.12, 95% CI ‐0.16, ‐0.09), a decrease in the risk pulmonary interstitial emphysema (PIE) (typical relative risk 0.46, 95% CI 0.36, 0.59; typical risk difference ‐0.16, 95% CI ‐0.21, ‐0.11), a decrease in the risk of neonatal mortality (typical relative risk 0.60, 95% CI 0.47, 0.77; typical risk difference ‐0.07, 95% CI ‐0.12, ‐0.03), and a decrease in the risk of BPD or death (typical relative risk 0.80, 95% CI 0.72, 0.88; typical risk difference ‐0.10, 95% CI ‐0.16, ‐0.04). No differences are reported in the risk of intraventricular hemorrhage, patent ductus arteriosus, necrotizing enterocolitis or retinopathy of prematurity. Few data are available on long‐term follow‐up of treated infants. Authors' conclusions Prophylactic intratracheal administration of animal derived surfactant extract to infants judged to be at risk of developing respiratory distress syndrome has been demonstrated to improve clinical outcome. Infants who receive prophylactic animal derived surfactant extract have a decreased risk of pneumothorax, a decreased risk of PIE, a decreased risk of mortality, and a decreased risk of BPD or death.