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Thresholds for surfactant use in preterm neonates: a network meta-analysis.
Aoife Branagan1,2, Ivan Yu3,2, Kurinchi Gurusamy2,4
1Paediatric and Newborn Medicine, Coombe Women and Infants University Hospital, Dublin, Ireland branagaa@tcd.ie.
Archives of Disease in Childhood. Fetal and Neonatal Edition
|January 5, 2023
Summary
This network meta-analysis found no significant benefit of different fraction of inspired oxygen (FiO2) thresholds for selective surfactant therapy in respiratory distress syndrome (RDS). A 60% FiO2 threshold suggested increased morbidity in preterm infants.
Area of Science:
- Neonatology
- Pulmonology
- Critical Care Medicine
Background:
- Respiratory distress syndrome (RDS) is a common condition in preterm infants.
- Surfactant therapy is a cornerstone in managing RDS, but optimal delivery strategies remain debated.
- Selective surfactant therapy aims to administer surfactant based on physiological parameters, such as fraction of inspired oxygen (FiO2).
Approach:
- A systematic review and Bayesian network meta-analysis of randomized controlled trials (RCTs) were conducted.
- Included trials focused on infants under 32 weeks gestational age receiving intratracheal surfactant.
- Primary outcome was neonatal mortality, with secondary outcomes including respiratory morbidity and major complications of prematurity.
Key Points:
- No statistically significant differences in neonatal mortality were observed between selective surfactant therapy using 30%, 40%, or 50% FiO2 thresholds.
- Sensitivity analysis in specific subgroups did not reveal significant differences in mortality or RDS.
- A 60% FiO2 threshold was associated with a potential increase in the combined outcome of major morbidities.
Conclusions:
- Current evidence does not support a clear benefit of surfactant treatment at any specific FiO2 threshold for selective therapy.
- The 60% FiO2 threshold warrants caution due to potential increased morbidity.
- Further high-quality RCTs are needed to establish optimal thresholds for surfactant delivery in RDS.
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