Objectives: To evaluate the effect of surfactant administration in the treatment of term infants with meconium aspiration syndrome.
Search strategy: Searches were made using Medline (1985 to January 2000) (MeSH terms: pulmonary surfactant and meconium aspiration; limits: age groups, newborns; publication type, clinical trials), previous reviews including cross-references, abstracts, conference and symposia proceedings, expert informants, and journal hand searching in the English language. Authors were directly contacted to provide additional data.
Selection criteria: Randomized controlled trials which evaluated the effect of surfactant administration in term infants with meconium aspiration syndrome are included in the analysis.
Data collection and analysis: Data regarding clinical outcomes including duration of assisted ventilation, duration of supplemental oxygen, pneumothorax, intraventricular hemorrhage (any grade and severe IVH), chronic lung disease, treatment with extracorporeal membrane oxygenation (ECMO), and mortality were excerpted from the reports of the clinical trails by the reviewers. Data analysis was done in accordance with the standards of the Cochrane Neonatal Review Group.
Main results: Two randomized controlled trials met inclusion criteria. Findlay (1996) reports a decrease in the risk of pneumothorax (relative risk 0.09, 95% CI 0.01, 1.54, risk difference -0.25, 95% CI -0.45, -0.05). Both Findlay (1996) and Lotze (1998) report a decrease in the number of infants receiving extracorporeal membrane oxygenation. The meta-analysis supports a significant reduction in the risk of requiring extracorporeal membrane oxygenation (typical relative risk 0.64, 95% CI 0.46, 0.91 typical risk difference -0.17, 95% CI -0.30, -0.04). No difference was noted in overall mortality (typical relative risk 1.86 95% CI 0.35, 9.89, typical risk difference 0.02 95% CI -0.03, 0.07).
Reviewer's conclusions: In infants with meconium aspiration syndrome, 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, and high frequency ventilation remains to be tested.