Protein containing synthetic surfactant versus animal derived surfactant extract for the prevention and treatment of respiratory distress syndrome

Robert H. Pfister; Roger Soll; Thomas E Wiswell

doi:10.1002/14651858.CD006069.pub3

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Analysis 1.1

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 1 Mortality at 28 days.

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Analysis 1.2

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 2 Mortality at 36 weeks postmenstrual age.

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Analysis 1.3

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 3 Chronic lung disease at 28 days.

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Analysis 1.4

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 4 Chronic lung disease at 36 weeks.

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Analysis 1.5

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 5 Chronic lung disease or death at 28 days.

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Analysis 1.6

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 6 Chronic lung disease or death at 36 weeks postmenstrual age.

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Analysis 1.7

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 7 Pulmonary interstitial emphysema.

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Analysis 1.8

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 8 Air leaks.

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Analysis 1.9

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 9 Pulmonary hemorrhage.

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Analysis 1.10

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 10 Respiratory distress syndrome at 24 hours.

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Analysis 1.11

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 11 Patent ductus arteriosis.

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Analysis 1.12

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 12 Proven sepsis.

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Analysis 1.13

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 13 Necrotizing enterocolitis.

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Analysis 1.14

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 14 Intraventricular hemorrhage.

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Analysis 1.15

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 15 Severe intraventricular hemorrhage (Grade III and IV).

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Analysis 1.16

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 16 Periventricular leukomalacia.

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Analysis 1.17

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 17 Retinopathy of prematurity.

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Analysis 1.18

Comparison 1 Protein containing synthetic surfactant vs animal derived sufactant (all patients), Outcome 18 Severe retinopathy of prematurity (Stage III or greater).

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Analysis 2.1

Comparison 2 Protein containing synthetic surfactant vs animal derived surfactant in infants at risk for RDS <1000g, Outcome 1 Mortality at 28 days.

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Analysis 2.2

Comparison 2 Protein containing synthetic surfactant vs animal derived surfactant in infants at risk for RDS <1000g, Outcome 2 Mortality at 36 weeks postmenstrual age.

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Analysis 2.3

Comparison 2 Protein containing synthetic surfactant vs animal derived surfactant in infants at risk for RDS <1000g, Outcome 3 Chronic lung disease at 28 days.

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Analysis 2.4

Comparison 2 Protein containing synthetic surfactant vs animal derived surfactant in infants at risk for RDS <1000g, Outcome 4 Chronic lung disease at 36 weeks.

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Analysis 2.5

Comparison 2 Protein containing synthetic surfactant vs animal derived surfactant in infants at risk for RDS <1000g, Outcome 5 Chronic lung disease or death at 28 days.

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Analysis 2.6

Comparison 2 Protein containing synthetic surfactant vs animal derived surfactant in infants at risk for RDS <1000g, Outcome 6 Chronic lung disease or death at 36 weeks postmenstrual age.

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Analysis 3.1

Comparison 3 Post Hoc Outcomes, Outcome 1 Unilateral or bilateral Deafness in survivors evaluated at 1 year.

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Analysis 3.2

Comparison 3 Post Hoc Outcomes, Outcome 2 Unilateral or bilateral Blindness in survivors evaluated at 1 year.

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Analysis 3.3

Comparison 3 Post Hoc Outcomes, Outcome 3 Known Deaths at 1 year.

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Comparison 1. Protein containing synthetic surfactant vs animal derived sufactant (all patients)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality at 28 days Show forest plot	2	1028	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.61, 1.02]

2 Mortality at 36 weeks postmenstrual age Show forest plot	2	1028	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.64, 1.03]

3 Chronic lung disease at 28 days Show forest plot	2	1028	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.89, 1.12]

4 Chronic lung disease at 36 weeks Show forest plot	2	1028	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.84, 1.18]

5 Chronic lung disease or death at 28 days Show forest plot	2	1028	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.88, 1.11]

6 Chronic lung disease or death at 36 weeks postmenstrual age Show forest plot	2	1028	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.82, 1.12]

7 Pulmonary interstitial emphysema Show forest plot	1	785	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [0.73, 1.80]

8 Air leaks Show forest plot	2	1028	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.73, 1.37]

9 Pulmonary hemorrhage Show forest plot	2	1028	Risk Ratio (M‐H, Fixed, 95% CI)	0.73 [0.51, 1.06]

10 Respiratory distress syndrome at 24 hours Show forest plot	1	785	Risk Ratio (M‐H, Fixed, 95% CI)	1.17 [0.96, 1.44]

11 Patent ductus arteriosis Show forest plot	1	243	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.74, 1.31]

12 Proven sepsis Show forest plot	1	785	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.85, 1.19]

13 Necrotizing enterocolitis Show forest plot	2	1028	Risk Ratio (M‐H, Fixed, 95% CI)	0.60 [0.42, 0.86]

14 Intraventricular hemorrhage Show forest plot	2	1028	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.88, 1.15]

15 Severe intraventricular hemorrhage (Grade III and IV) Show forest plot	1	243	Risk Ratio (M‐H, Fixed, 95% CI)	1.52 [0.73, 3.13]

16 Periventricular leukomalacia Show forest plot	2	1028	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.53, 1.19]

17 Retinopathy of prematurity Show forest plot	2	1028	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.86, 1.32]

18 Severe retinopathy of prematurity (Stage III or greater) Show forest plot	1	243	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.50, 1.20]

Comparison 1. Protein containing synthetic surfactant vs animal derived sufactant (all patients)

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Comparison 2. Protein containing synthetic surfactant vs animal derived surfactant in infants at risk for RDS <1000g

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality at 28 days Show forest plot	1	160	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.41, 1.51]

2 Mortality at 36 weeks postmenstrual age Show forest plot	1	160	Risk Ratio (M‐H, Fixed, 95% CI)	0.92 [0.53, 1.61]

3 Chronic lung disease at 28 days Show forest plot	1	160	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.81, 1.35]

4 Chronic lung disease at 36 weeks Show forest plot	1	160	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [0.72, 2.29]

5 Chronic lung disease or death at 28 days Show forest plot	1	160	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.83, 1.15]

6 Chronic lung disease or death at 36 weeks postmenstrual age Show forest plot	1	160	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.77, 1.51]

Comparison 2. Protein containing synthetic surfactant vs animal derived surfactant in infants at risk for RDS <1000g

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Comparison 3. Post Hoc Outcomes

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Unilateral or bilateral Deafness in survivors evaluated at 1 year Show forest plot	2	642	Risk Ratio (M‐H, Fixed, 95% CI)	4.77 [0.62, 36.92]

2 Unilateral or bilateral Blindness in survivors evaluated at 1 year Show forest plot	2	642	Risk Ratio (M‐H, Fixed, 95% CI)	1.29 [0.38, 4.41]

3 Known Deaths at 1 year Show forest plot	2	1037	Risk Ratio (M‐H, Fixed, 95% CI)	0.92 [0.74, 1.14]

Comparison 3. Post Hoc Outcomes

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