25 Antithrombin for the Treatment of Respiratory Distress Syndrome: A Systematic Review

Abstract

BACKGROUND Acquired Antithrombin (AT) deficiency is a common and prognostically important finding in sick preterm infants with respiratory distress syndrome (RDS). It has been hypothesised that AT concentrate may improve clinical outcomes in preterm infants with RDS. We examined whether the administration of AT concentrate decreased mortality in preterm infants compared with placebo or no treatment.METHODS We did a systematic review of trials that compared any dose and duration of AT therapy with placebo or no treatment in preterm infants with RDS. We used the methods of the Cochrane Collaboration. We combined data for similar outcomes where appropriate, using a fixed-effects model.FINDINGS 2 trials consisting of 182 preterm infants, fulfilled the inclusion criteria. Mean gestational age of patients included was 28 weeks. In one trial patients had to be endotracheally intubated and ventilated for RDS to be eligible for the study. In the other trial RDS was not mentioned as an inclusion criteria, however 93% of infants in the control group received surfactant. No individual trial showed a significant difference in mortality, however one of the trials was stopped early because of an observed inbalance in deaths between the treatment groups. The pooled analysis for mortality within the first week of life showed a relative risk of 1.6 (95% CI 0.54–4.72) in favour of the control group. Only the trial that was stopped early followed the infants long enough to report neonatal mortality. This trial reported 7 deaths (11.5%) in the AT group and 2 deaths (3.3%) in the placebo group within 28 days of life. Secondary outcomes included days of mechanical ventilation and supplemental oxygen which were only reported in 1 trial. Both outcomes were in favour of the control group (statistical significant).INTERPRETATION Preterm infants with RDS do not benefit from AT treatment and may be harmed.