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Neonatal Med > Volume 18(2); 2011 > Article
Journal of the Korean Society of Neonatology 2011;18(2):189-196.
DOI: https://doi.org/10.5385/jksn.2011.18.2.189    Published online November 25, 2011.
The Effect on Pulmonary Indices of Surfactant Therapy for Meconium Aspiration Syndrome: Systematic Review and Meta-analysis.
Hyun Jin Choi, Seokyung Hahn, Soon Min Lee, Han suk Kim, Chong Woo Bae
1Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
2Department of Medicine, Seoul National University College of Medicine, Seoul, Korea. hahns@snu.ac.kr
3Department of Pediatrics, College of Medicine, Yonsei University, Seoul, Korea.
4Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
5Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea.
Surfactants have been used to improve oxygenation for infants with meconium aspiration syndrome (MAS). We evaluated the change of pulmonary indices after surfactant therapy for MAS through a systematic meta-analysis.
Relevant randomized controlled studies (RCTs) were identified by database searches in MEDLINE, EMBASE, and CENTRAL, up to June 2011, and by additional hand searches. Data were extracted regarding pulmonary indices, such as the oxygen index and arterial alveolar oxygen gradient. Meta-analyses were separately conducted for the studies of surfactant lavage therapy and surfactant bolus therapy. The risk of bias was assessed, and clinical as well as statistical heterogeneities were also investigated.
Two RCTs for bolus surfactant therapy and two RCTs for surfactant lavage therapy were identified. The oxygenation index results were heterogeneous between the two studies in which bolus surfactant therapy was given, while a/A PO2 showed significantly better results in the treatment group over time after use of surfactant (12 hours: WMD 0.08, 95% CI 0.04-0.12; 24 hours: WMD 0.17, 95% CI 0.06-0.28). For surfactant lavage therapy, both studies consistently suggested an interventional benefit in terms of the pulmonary indices although it did not reach statistical significance.
Surfactant therapy appeared to improve oxygenation of infants with MAS. Since a limited number of RCTs are available in the current literature and those studies were also clinically heterogeneous in terms of illness severity and the method of surfactant use, further research is needed to gather evidence to support surfactant therapy in MAS.
Key Words: Meconium, Meconium aspiration, Surfactant, Pulmonary surfactant, Neonate


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