Systematic Review and Meta-Analysis
Surfactant Lavage Therapy for Meconium Aspiration Syndrome: A Systematic Review and Meta-AnalysisChoi H.J.a, g · Hahn S.b, d, g · Lee J.d · Park B.-J.a, d, g · Lee S.M.e · Kim H.-S.c · Bae C.-W.f
Departments of aPreventive Medicine, bMedicine and cPediatrics, Seoul National University College of Medicine, dMedical Research Collaborating Center, Seoul National University Hospital, eDepartment of Pediatrics, Yonsei University College of Medicine, fDepartment of Pediatrics, Kyung Hee University School of Medicine, and gNational Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
Seokyung Hahn, PhD
Department of Medicine
Seoul National University College of Medicine
28 Yongon-dong, Chongno-gu, Seoul 110-744 (Korea)
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Background: Lung lavage with diluted surfactant has emerged as an innovative treatment for meconium aspiration syndrome (MAS). However, the treatment effect has not yet been fully established. Objective: To investigate the effects of surfactant lavage therapy for MAS by a systematic meta-analysis. Methods: Relevant studies were identified by database searches in MEDLINE (from 1950), EMBASE (from 1980), and CENTRAL, up to June 2010, and by additional hand searches. Meta-analyses were separately conducted for randomized controlled trials (RCTs) and non-randomized controlled studies (NRSs). Risk of bias was assessed and clinical as well as statistical heterogeneities were also investigated in explaining the potential bias. Results: Two RCTs (87 patients) and eight NRSs (178 patients) were identified. From the results of the meta-analysis of RCTs, surfactant lavage significantly decreased death or the need for extracorporeal membrane oxygenation (RR 0.34, 95% CI 0.11, 0.99). An interventional benefit was indicated for other outcomes, although it was not statistically significant based only on the two RCTs. Results from the analysis of outcomes from NRSs are consistent with those from RCTs and demonstrated a beneficial effect, which could be considered as supporting evidence. Conclusions: Lung lavage with diluted surfactant appeared to improve the clinical outcome in infants with MAS. Given that less than 100 infants were included in the two RCTs, the findings of this study may still be regarded as insufficient evidence. Further research will be needed to confirm the benefit as well as to refine the lavage technique.
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