Paediatric and Newborn Medicine, Coombe Women and Infants University Hospital, Dublin, Ireland
Division of Surgery and Interventional Science, UCL, London, UK.
Arch Dis Child Fetal Neonatal Ed. 2023 Jul;108(4):333-341. doi: 10.1136/archdischild-2022-324184. Epub 2022 Dec 9.
To perform a network meta-analysis of randomised controlled trials of different surfactant treatment strategies for respiratory distress syndrome (RDS) to assess if a certain fraction of inspired oxygen (FiO) is optimal for selective surfactant therapy.
Systematic review and network meta-analysis using Bayesian analysis of randomised trials of prophylactic versus selective surfactant for RDS.
Cochrane Central Register of Controlled Trials, MEDLINE, Embase and Science Citation Index Expanded.
Randomised trials including infants under 32 weeks of gestational age.
Intratracheal surfactant, irrespective of type or dose.
Our primary outcome was neonatal mortality, compared between groups treated with selective surfactant therapy at different thresholds of FiO. Secondary outcomes included respiratory morbidity and major complications of prematurity.
Of 4643 identified references, 14 studies involving 5298 participants were included. We found no statistically significant differences between 30%, 40% and 50% FiO thresholds. A sensitivity analysis of infants treated in the era of high antenatal steroid use and nasal continuous positive airway pressure as initial mode of respiratory support showed no difference in mortality, RDS or intraventricular haemorrhage alone but suggested an increase in the combined outcome of major morbidities in the 60% threshold.
Our results do not show a clear benefit of surfactant treatment at any threshold of FiO. The 60% threshold was suggestive of increased morbidity. There was no advantage seen with prophylactic treatment. Randomised trials of different thresholds for surfactant delivery are urgently needed to guide clinicians and provide robust evidence.
CRD42020166620.
对不同表面活性剂治疗策略治疗呼吸窘迫综合征（RDS）的随机对照试验进行网络荟萃分析，以评估吸入氧分数（FiO）的特定分数是否对选择性表面活性剂治疗最优化。
使用贝叶斯分析对 RDS 的预防性与选择性表面活性剂治疗的随机试验进行系统评价和网络荟萃分析。
Cochrane 对照试验中心注册库、MEDLINE、Embase 和科学引文索引扩展版。
纳入胎龄小于 32 周的随机试验婴儿。
气管内表面活性剂，无论类型或剂量如何。
我们的主要结局是比较不同 FiO 阈值下接受选择性表面活性剂治疗的组之间的新生儿死亡率。次要结局包括呼吸发病率和早产儿的主要并发症。
在 4643 篇确定的参考文献中，纳入了 14 项涉及 5298 名参与者的研究。我们没有发现 30%、40%和 50% FiO 阈值之间存在统计学显著差异。在高产前类固醇使用和鼻持续气道正压通气作为初始呼吸支持模式的时代治疗的婴儿的敏感性分析中，死亡率、RDS 或单独的脑室出血没有差异，但在 60%阈值下，主要并发症的联合结局有增加的趋势。
我们的结果表明，在任何 FiO 阈值下，表面活性剂治疗都没有明显的益处。60%的阈值提示发病率增加。预防性治疗没有优势。迫切需要进行不同表面活性剂输送阈值的随机试验，以指导临床医生并提供可靠的证据。
PROSPERO 注册号：CRD42020166620。
