PRS6 - THE CLINICAL EFFECTIVENESS OF PROPHYLACTIC VERSUS SELECTIVE USE OF SURFACTANT IN PRETERM INFANTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Surfactant therapy is widely used to prevent or treat respiratory distress syndrome (RDS) in preterm infants. As advance with perinatal care such as antenatal steroid use and early application of nasal continuous positive airway pressure (nCPAP), there is a concern that surfactant is administrated even in infants who will not go on to develop RDS. To compare the clinical effectiveness of prophylactic and selective use of surfactant in preterm infants by a systematic review and meta-analysis. A systematic review was conducted to examine the clinical effects of selective and prophylactic surfactant use on preterm infants. The search was made in international databases (Medline, EMBASE, Cochrane library) and Korean databases up to June 2017. Primary outcomes were mortality and bronchopulmonary dysplasia (BPD). Following morbidities before discharge were analyzed; air leak disease, pulmonary hemorrhage, patent ductus arteriosus, sepsis, necrotizing enterocolitis, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, pulmonary hypertension, pneumonia. A total of 16 articles were selected. There were 12 randomized controlled trials (6,544 patients) and 4 non-randomized controlled studies (884 patients). Selective use of surfactant increased the neonatal mortality (RR 1.33, 95% CI: 1.10-1.60, P=0.008) and the combined outcome of neonatal mortality and BPD (RR 1.16, 95% CI: 1.03-1.30, P=0.01). However, there were no significant differences between prophylactic and selective use of surfactant about these outcomes by each subgroup analysis of more than 30 weeks gestation, more than 50% of antenatal steroid use, and nCPAP application. There were no significant differences of other morbidities between prophylactic and selective use of surfactant. In preterm infants at risk of RDS, prophylactic use of surfactant prevents the neonatal mortality and BPD. However, selective use of surfactant may be considered in case of more than 30 weeks gestation, antenatal steroid use and the early application of nCPAP.