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Cochrane Database of Systematic Reviews

Usporedba učinkovitosti životinjskog surfaktanta za prevenciju i liječenje sindroma respiratornoga poremećaja (distresa, RDS) u prijevremeno rođene djece

Información

DOI:
https://doi.org/10.1002/14651858.CD010249.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 21 diciembre 2015see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Neonatología

Copyright:
  1. Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

  • Neetu Singh

    Correspondencia a: Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, USA

    [email protected]

  • Henry L Halliday

    Honorary Professor of Child Health, Queen's University (Retired), Belfast, UK

  • Timothy P Stevens

    Pediatrics, University of Rochester, Rochester, USA

  • Gautham Suresh

    Department of Pediatrics, Neonatal Division, Dartmouth‐Hitchcock Medical Center, Lebanon, USA

  • Roger Soll

    Division of Neonatal‐Perinatal Medicine, University of Vermont Medical Center, Burlington, USA

  • Maria Ximena Rojas‐Reyes

    Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia

Contributions of authors

Drs Singh, Halliday, Soll, and Stevens all participated in drafting and reviewing the protocol for the systematic review of 'Comparison of animal‐derived surfactants for the prevention and treatment of respiratory distress syndrome in preterm infants'. Dr. Suresh performed an independent literature search, and reviewed the content and the language of the review. Dr. Rojas performed the assessment of the evidence quality following the GRADE approach, developed the 'Summary of findings' tables and included the quality‐of‐evidence‐related aspects to the review.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services, USA.

    Editorial support of the Cochrane Neonatal Review Group has been funded with Federal funds from the Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services, USA, under Contract No. HHSN275201100016C.

Declarations of interest

Dr Soll has previously acted as a consultant for several of the pharmaceutical companies that manufacture surfactant preparations (Abbott Laboratories, Ross Laboratories, Chiesi Farmaceutici, Dey Laboratories, Burroughs Wellcome). Dr. Soll has not acted as a paid consultant for the past nine years.

Dr Halliday is currently a consultant for Chiesi Farmaceutici, a pharmaceutical company that manufactures a porcine‐derived surfactant preparation; and has been an invited speaker at meetings supported by Abbott Laboratories, Ross Laboratories and Burroughs Wellcome.

Dr Stevens has no known conflicts of interest. This will be further clarified prior to publication of the review.

Dr Singh has no conflict of interest to report.

Dr Suresh has no conflict of interest to report.

Dr. Rojas has no conflict of interest to report.

Acknowledgements

We would like to thank Paola Orrego, medical student participant of the "Seed Research Program in Systematic Reviews" at the Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia for input and assistance in creating the 'Summary of Findings' tables.

Version history

Published

Title

Stage

Authors

Version

2015 Dec 21

Comparison of animal‐derived surfactants for the prevention and treatment of respiratory distress syndrome in preterm infants

Review

Neetu Singh, Henry L Halliday, Timothy P Stevens, Gautham Suresh, Roger Soll, Maria Ximena Rojas‐Reyes

https://doi.org/10.1002/14651858.CD010249.pub2

2012 Nov 14

Comparison of animal‐derived surfactants for the prevention and treatment of respiratory distress syndrome in preterm infants

Protocol

Neetu Singh, Henry L Halliday, Timothy P Stevens, Roger Soll

https://doi.org/10.1002/14651858.CD010249

Differences between protocol and review

Methodology for 'Summary of findings' tables added.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Forest plot of comparison: 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, outcome: 1.2 Mortality prior to discharge.
Figuras y tablas -
Figure 1

Forest plot of comparison: 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, outcome: 1.2 Mortality prior to discharge.

Forest plot of comparison: 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, outcome: 1.4 Oxygen requirement at 36 weeks postmenstrual age (all infants).
Figuras y tablas -
Figure 2

Forest plot of comparison: 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, outcome: 1.4 Oxygen requirement at 36 weeks postmenstrual age (all infants).

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 1 Neonatal mortality.
Figuras y tablas -
Analysis 1.1

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 1 Neonatal mortality.

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 2 Mortality prior to discharge.
Figuras y tablas -
Analysis 1.2

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 2 Mortality prior to discharge.

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 3 Oxygen requirement at 28 to 30 days of age (all infants).
Figuras y tablas -
Analysis 1.3

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 3 Oxygen requirement at 28 to 30 days of age (all infants).

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 4 Oxygen requirement at 36 weeks postmenstrual age (all infants).
Figuras y tablas -
Analysis 1.4

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 4 Oxygen requirement at 36 weeks postmenstrual age (all infants).

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 5 Death or oxygen requirement at 28 to 30 days of age.
Figuras y tablas -
Analysis 1.5

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 5 Death or oxygen requirement at 28 to 30 days of age.

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 6 Death or oxygen requirement at 36 weeks postmenstrual age.
Figuras y tablas -
Analysis 1.6

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 6 Death or oxygen requirement at 36 weeks postmenstrual age.

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 7 Received > one dose of surfactant.
Figuras y tablas -
Analysis 1.7

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 7 Received > one dose of surfactant.

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 8 Pneumothorax.
Figuras y tablas -
Analysis 1.8

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 8 Pneumothorax.

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 9 Air leak syndromes.
Figuras y tablas -
Analysis 1.9

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 9 Air leak syndromes.

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 10 Pulmonary hemorrhage.
Figuras y tablas -
Analysis 1.10

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 10 Pulmonary hemorrhage.

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 11 Treated patent ductus arteriosus (PDA).
Figuras y tablas -
Analysis 1.11

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 11 Treated patent ductus arteriosus (PDA).

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 12 Culture‐confirmed bacterial sepsis.
Figuras y tablas -
Analysis 1.12

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 12 Culture‐confirmed bacterial sepsis.

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 13 Necrotizing enterocolitis (any stage).
Figuras y tablas -
Analysis 1.13

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 13 Necrotizing enterocolitis (any stage).

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 14 Periventricular leukomalacia.
Figuras y tablas -
Analysis 1.14

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 14 Periventricular leukomalacia.

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 15 Retinopathy of prematurity in infants examined (all stages).
Figuras y tablas -
Analysis 1.15

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 15 Retinopathy of prematurity in infants examined (all stages).

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 16 Retinopathy of prematurity in infants examined (severe stage 3 or greater).
Figuras y tablas -
Analysis 1.16

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 16 Retinopathy of prematurity in infants examined (severe stage 3 or greater).

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 17 Intraventricular hemorrhage in infants receiving neuroimaging (all grades).
Figuras y tablas -
Analysis 1.17

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 17 Intraventricular hemorrhage in infants receiving neuroimaging (all grades).

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 18 Severe IVH in infants receiving neuroimaging.
Figuras y tablas -
Analysis 1.18

Comparison 1 Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract, Outcome 18 Severe IVH in infants receiving neuroimaging.

Comparison 2 Bovine lung lavage surfactant vs. porcine minced lung, Outcome 1 Mortality prior to discharge.
Figuras y tablas -
Analysis 2.1

Comparison 2 Bovine lung lavage surfactant vs. porcine minced lung, Outcome 1 Mortality prior to discharge.

Comparison 2 Bovine lung lavage surfactant vs. porcine minced lung, Outcome 2 Oxygen requirement at 36 weeks postmenstrual age.
Figuras y tablas -
Analysis 2.2

Comparison 2 Bovine lung lavage surfactant vs. porcine minced lung, Outcome 2 Oxygen requirement at 36 weeks postmenstrual age.

Comparison 2 Bovine lung lavage surfactant vs. porcine minced lung, Outcome 3 Air leak syndromes.
Figuras y tablas -
Analysis 2.3

Comparison 2 Bovine lung lavage surfactant vs. porcine minced lung, Outcome 3 Air leak syndromes.

Comparison 2 Bovine lung lavage surfactant vs. porcine minced lung, Outcome 4 Necrotizing enterocolitis (any stage).
Figuras y tablas -
Analysis 2.4

Comparison 2 Bovine lung lavage surfactant vs. porcine minced lung, Outcome 4 Necrotizing enterocolitis (any stage).

Comparison 2 Bovine lung lavage surfactant vs. porcine minced lung, Outcome 5 Retinopathy of prematurity in infants examined (all stages).
Figuras y tablas -
Analysis 2.5

Comparison 2 Bovine lung lavage surfactant vs. porcine minced lung, Outcome 5 Retinopathy of prematurity in infants examined (all stages).

Comparison 2 Bovine lung lavage surfactant vs. porcine minced lung, Outcome 6 Severe IVH.
Figuras y tablas -
Analysis 2.6

Comparison 2 Bovine lung lavage surfactant vs. porcine minced lung, Outcome 6 Severe IVH.

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 1 Neonatal mortality.
Figuras y tablas -
Analysis 3.1

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 1 Neonatal mortality.

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 2 Mortality prior to discharge.
Figuras y tablas -
Analysis 3.2

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 2 Mortality prior to discharge.

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 3 Oxygen requirement at 28 to 30 days of age.
Figuras y tablas -
Analysis 3.3

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 3 Oxygen requirement at 28 to 30 days of age.

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 4 Oxygen requirement at 36 weeks postmenstrual age.
Figuras y tablas -
Analysis 3.4

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 4 Oxygen requirement at 36 weeks postmenstrual age.

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 5 Death or oxygen requirement at 36 weeks postmenstrual age.
Figuras y tablas -
Analysis 3.5

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 5 Death or oxygen requirement at 36 weeks postmenstrual age.

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 6 Received > one dose of surfactant.
Figuras y tablas -
Analysis 3.6

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 6 Received > one dose of surfactant.

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 7 Pneumothorax.
Figuras y tablas -
Analysis 3.7

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 7 Pneumothorax.

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 8 Air leak syndromes.
Figuras y tablas -
Analysis 3.8

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 8 Air leak syndromes.

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 9 Pulmonary hemorrhage.
Figuras y tablas -
Analysis 3.9

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 9 Pulmonary hemorrhage.

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 10 Treated patent ductus arteriosus (PDA).
Figuras y tablas -
Analysis 3.10

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 10 Treated patent ductus arteriosus (PDA).

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 11 Culture‐confirmed bacterial sepsis.
Figuras y tablas -
Analysis 3.11

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 11 Culture‐confirmed bacterial sepsis.

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 12 Necrotizing enterocolitis (any stage).
Figuras y tablas -
Analysis 3.12

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 12 Necrotizing enterocolitis (any stage).

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 13 Periventricular leukomalacia.
Figuras y tablas -
Analysis 3.13

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 13 Periventricular leukomalacia.

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 14 Retinopathy of prematurity in infants examined (all stages).
Figuras y tablas -
Analysis 3.14

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 14 Retinopathy of prematurity in infants examined (all stages).

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 15 Retinopathy of prematurity in infants examined (severe stage 3 or greater).
Figuras y tablas -
Analysis 3.15

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 15 Retinopathy of prematurity in infants examined (severe stage 3 or greater).

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 16 Intraventricular hemorrhage (all grades).
Figuras y tablas -
Analysis 3.16

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 16 Intraventricular hemorrhage (all grades).

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 17 Severe IVH.
Figuras y tablas -
Analysis 3.17

Comparison 3 Modified bovine minced lung vs. porcine minced lung, Outcome 17 Severe IVH.

Comparison 4 Modified bovine minced lung vs. porcine lung lavage, Outcome 1 Mortality prior to discharge.
Figuras y tablas -
Analysis 4.1

Comparison 4 Modified bovine minced lung vs. porcine lung lavage, Outcome 1 Mortality prior to discharge.

Comparison 4 Modified bovine minced lung vs. porcine lung lavage, Outcome 2 Pneumothorax.
Figuras y tablas -
Analysis 4.2

Comparison 4 Modified bovine minced lung vs. porcine lung lavage, Outcome 2 Pneumothorax.

Comparison 5 Modified bovine minced lung vs. porcine minced lung (based on initial surfactant dosage), Outcome 1 Neonatal mortality.
Figuras y tablas -
Analysis 5.1

Comparison 5 Modified bovine minced lung vs. porcine minced lung (based on initial surfactant dosage), Outcome 1 Neonatal mortality.

Comparison 5 Modified bovine minced lung vs. porcine minced lung (based on initial surfactant dosage), Outcome 2 Mortality prior to discharge.
Figuras y tablas -
Analysis 5.2

Comparison 5 Modified bovine minced lung vs. porcine minced lung (based on initial surfactant dosage), Outcome 2 Mortality prior to discharge.

Comparison 5 Modified bovine minced lung vs. porcine minced lung (based on initial surfactant dosage), Outcome 3 Oxygen requirement at 28 to 30 days of age.
Figuras y tablas -
Analysis 5.3

Comparison 5 Modified bovine minced lung vs. porcine minced lung (based on initial surfactant dosage), Outcome 3 Oxygen requirement at 28 to 30 days of age.

Comparison 5 Modified bovine minced lung vs. porcine minced lung (based on initial surfactant dosage), Outcome 4 Oxygen requirement at 36 weeks postmenstrual age.
Figuras y tablas -
Analysis 5.4

Comparison 5 Modified bovine minced lung vs. porcine minced lung (based on initial surfactant dosage), Outcome 4 Oxygen requirement at 36 weeks postmenstrual age.

Comparison 5 Modified bovine minced lung vs. porcine minced lung (based on initial surfactant dosage), Outcome 5 Death or oxygen requirement at 36 weeks postmenstrual age.
Figuras y tablas -
Analysis 5.5

Comparison 5 Modified bovine minced lung vs. porcine minced lung (based on initial surfactant dosage), Outcome 5 Death or oxygen requirement at 36 weeks postmenstrual age.

Summary of findings for the main comparison. Bovine lung lavage surfactant extract compared with modified bovine minced lung surfactant extract in preterm infants for prevention of RDS

Bovine lung lavage surfactant extract compared with modified bovine minced lung surfactant extract in preterm infants for prevention of RDS (Comparision 1: Prevention studies)

Patient or population: Preterm infants for prevention of RDS
Setting: Hospital
Intervention: Bovine lung lavage surfactant extract
Comparison: Modified bovine minced lung surfactant extract

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with modified bovine minced lung surfactant extract

Risk with Bovine lung lavage surfactant extract

Mortality prior to discharge (from any cause)

107 per 1000

133 per 1000
(96 to 183)

RR 1.24
(0.90 to 1.71)

1123
(2 RCTs)

⨁⨁⨁◯
MODERATE 1

Downgraded one level due to imprecision (95% CI includes both no effect and appreciable harm) and and the total number of events does not meet the optimal information size (OIS).

Oxygen requirement at 36 weeks' postmenstrual age

341 per 1000

331 per 1000
(270 to 406)

RR 0.97
(0.79 to 1.19)

749
(1 RCT)

⨁⨁⨁◯
MODERATE 2

Downgraded one level due to imprecision (95% CI includes both no effect and appreciable harm).

Death or oxygen requirement at 36 weeks' postmenstrual age

409 per 1000

418 per 1000
(364 to 479)

RR 1.02
(0.89 to 1.17)

1133
(2 RCTs)

⨁⨁⨁⨁
HIGH

We did not downgrade evidence for imprecision as it was considered that 95% CI is narrow and precise around the no effect. The total number of events meets the OIS

Pneumothorax.

67 per 1000

51 per 1000
(29 to 91)

RR 0.76
(0.43 to 1.36)

749
(1 RCT)

⨁⨁⨁◯
MODERATE 2

Downgraded one level due to imprecision (95% CI includes both no effect and appreciable harm)

Pulmonary hemorrhage

44 per 1000

63 per 1000
(39 to 105)

RR 1.44
(0.88 to 2.39)

1123
(2 RCTs)

⨁⨁◯◯
LOW 3

Downgraded two levels due to very serious imprecision: 1) the 95% CI includes both no effect and appreciable harm. 2) the total number of events does not meet the optimal information size (OIS to detect a clinically beneficial effect if there is one is > 3000)

Severe IVH in infants receiving neuroimaging

87 per 1000

112 per 1000
(78 to 160)

RR 1.28
(0.89 to 1.83)

1087
(2 RCTs)

⨁⨁◯◯
LOW 4

Downgraded two levels due to very serious imprecision: 1) 95% CI includes both no effect and appreciable harm.2) The total number of events does not meet the optimal information size (OIS to detect a clinically beneficial effect if there is one is > 2000).

Neurodevelopmental outcome at approximately two years’ corrected age

see comments

see comments

Not reported in any of the studies

*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 95% CI includes benefit, no effect and appreciable harm and the total number of events does not meet the optimal information size

2 95% CI includes benefit, no effect and appreciable harm

3 95% CI includes benefit, no effect and appreciable harm and the OIS to detect a clinically beneficial effect if there is one is > 3000

4 95% CI includes benefit, no effect and appreciable harm and the OIS to detect a clinically beneficial effect if there is one is > 2000

Figuras y tablas -
Summary of findings for the main comparison. Bovine lung lavage surfactant extract compared with modified bovine minced lung surfactant extract in preterm infants for prevention of RDS
Summary of findings 2. Bovine lung lavage surfactant extract compared with modified bovine minced lung surfactant extract in preterm infants for treatment of RDS

Bovine lung lavage surfactant extract compared with modified bovine minced lung surfactant extract in preterm infants for treatment of RDS

Patient or population: Preterm infants for treatment of RDS
Setting: Hospital
Intervention: Bovine lung lavage surfactant extract
Comparison: Modified bovine minced lung surfactant extract

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with modified bovine minced lung surfactant extract

Risk with Bovine lung lavage surfactant extract

Mortality prior to discharge

131 per 1000

128 per 1000
(103 to 158)

RR 0.98
(0.79 to 1.21)

2231
(6 RCTs)

⨁⨁⨁◯
MODERATE 1

Downgraded one level due to imprecision (95% CI includes both no effect and appreciable harm) and the total number of events does not meet the OIS.

Oxygen requirement at 36 weeks' postmenstrual age (all infants)

312 per 1000

297 per 1000
(256 to 347)

RR 0.95
(0.82 to 1.11)

1564
(5 RCTs)

⨁⨁⨁⨁
HIGH

We did not downgrade evidence for imprecision as it was considered that 95% CI is narrow and precise around the probability of no effect. Estimations are based in more than 300 events in each arm.

Death or oxygen requirement at 36 weeks' postmenstrual age

421 per 1000

400 per 1000
(362 to 446)

RR 0.95
(0.86 to 1.06)

2009
(3 RCTs)

⨁⨁⨁⨁
HIGH

We did not downgrade evidence for imprecision as it was considered that 95% CI is narrow and precise around the probability of no effect. Estimations are based in more than 300 events in each arm.

Pneumothorax

73 per 1000

83 per 1000
(62 to 110)

RR 1.14
(0.85 to 1.51)

2224
(6 RCTs)

⨁⨁◯◯
LOW 1 2

Downgraded two levels due to:

1) Serious imprecision (95% CI includes both no effect and appreciable harm).

2) Inconsistency: Unexplained heterogeneity, with point estimates widely different; 95% CI not overlapping and leading to different conclusions (P value 0.03, Chi² 10.66, I² = 62%)

Pulmonary hemorrhage

44 per 1000

48 per 1000
(33 to 71)

RR 1.08
(0.74 to 1.59)

2138
(4 RCTs)

⨁⨁⨁◯
MODERATE 1

Downgraded one level due to imprecision (95% CI includes both no effect and appreciable harm)

Severe IVH in infants receiving neuroimaging

125 per 1000

108 per 1000
(85 to 136)

RR 0.86
(0.68 to 1.09)

2040
(5 RCTs)

⨁⨁⨁◯
MODERATE 3

Downgraded one level due to imprecision (95% CI includes benefits, no effect and appreciable harm). The optimal information size to reliably detect a clinically beneficial effect if there is one is > 7000

Neurodevelopmental outcome at approximately two years’ corrected age

see comments

see comments

Not reported in any of the studies

*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 95% CI includes benefits, no effect and appreciable harm, and the total number of events does not meet the OIS

2 Unexplained heterogeneity, with point estimates widely different and CI not overlapping and leading to different conclusions (P value 0.03, Chi² 10.66, I² = 62%)

3 95% CI of the pooled effect crosses 1 and the optimal information size to reliably detect a clinically beneficial effect if there is one is > 7000

Figuras y tablas -
Summary of findings 2. Bovine lung lavage surfactant extract compared with modified bovine minced lung surfactant extract in preterm infants for treatment of RDS
Summary of findings 3. Bovine lung lavage surfactant extract compared with porcine minced lung surfactant extract in preterm infants for treatment of RDS

Bovine lung lavage surfactant extract compared with porcine minced lung surfactant extract in preterm infants for treatment of RDS

Patient or population: Preterm infants for treatment of RDS
Setting: Hospital
Intervention: Bovine lung lavage surfactant extract
Comparison: Porcine minced lung surfactant extract

Outcomes

Anticipated absolute effects*

(95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with porcine minced lung surfactant extract

Risk with Bovine lung lavage surfactant extract

Mortality prior to discharge

185 per 1000

259 per 1000
(94 to 717)

RR 1.40
(0.51 to 3.87)

54
(1 RCT)

⨁⨁◯◯
LOW 1

Downgraded two levels due to very serious imprecision: 1) the 95% CI includes both no effect and appreciable harm.

2) the total number of events does not meet the optimal information size (OIS to detect a clinically beneficial effect if there is one is > 1000)

Oxygen requirement at 36 weeks' postmenstrual age

148 per 1000

111 per 1000
(28 to 450)

RR 0.75
(0.19 to 3.04)

54
(1 RCT)

⨁⨁◯◯
LOW 1

Downgraded two levels due to:

1. Serious imprecision (95% CI includes both no effect and appreciable harm).

2. Total number of events does not meet the optimal information size (OIS to detect a clinically beneficial effect if there is one is > 1000)

Death or oxygen requirement at 36 weeks' postmenstrual age

see comments

see comments

Not reported in any of the studies

Pneumothorax

see comments

see comments

Not reported in any of the studies

Pulmonary hemorrhage

see comments

see comments

Not reported in any of the studies

Severe intraventricular hemorrhage in infants who received neuroimaging

222 per 1000

184 per 1000
(64 to 536)

RR 0.83
(0.29 to 2.41)

54
(1 RCT)

⨁◯◯◯
VERY LOW 2 3

Downgraded three levels due to:

1. potential risk of bias (lack of blinding of outcome assessment)

2. very serious imprecision: (95% CI includes both no effect and appreciable harm) and the total number of events does not meet the optimal information size (OIS to detect a clinically beneficial effect if there is one is > 1000)

Neurodevelopmental outcome at approximately two years’ corrected age

see comments

see comments

Not reported in any of the studies

*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 95% CI of the pooled effect crosses 1 and the optimal information size to detect a clinically beneficial effect if there is one is > 1000

2 We downgraded because lack of blinding of patients, providers and blinding of outcome assessment

3 95% CI of the pooled effect crosses 1 and the optimal information size to detect a clinically beneficial effect if there is one is > 1000

Figuras y tablas -
Summary of findings 3. Bovine lung lavage surfactant extract compared with porcine minced lung surfactant extract in preterm infants for treatment of RDS
Summary of findings 4. Modified bovine minced lung surfactant extract compared with porcine minced lung surfactant extract in preterm infants for treatment of RDS

Modified bovine minced lung surfactant extract compared with porcine minced lung surfactant extract in preterm infants for treatment of RDS

Patient or population: Preterm infants for treatment of RDS
Setting: Hospital
Intervention: Modified bovine minced lung surfactant extract
Comparison: Porcine minced lung surfactant extract

Outcomes

Anticipated absolute effects*

(95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with porcine minced lung surfactant extract

Risk with Modified bovine minced lung surfactant extract

Mortality prior to hospital discharge (from any cause)

113 per 1000

162 per 1000
(117 to 225)

RR 1.44
(1.04 to 2.00)

901
(9 RCTs)

⨁⨁⨁◯
MODERATE 1

Downgraded one level due to imprecision (95% CI includes both no effect and appreciable harm).

Despite the high risk of bias4 we did not downgrade the quality because of its lower impact on this outcome.

Oxygen requirement at 36 weeks' postmenstrual age

282 per 1000

293 per 1000
(234 to 370)

RR 1.04 (0.83 to 1.31)

773
(8RCTs)

⨁⨁⨁◯
MODERATE 2

Downgraded one level due to imprecision (95% CI includes both no effect and appreciable harm).

Despite the high risk of bias4 we did not downgrade the quality because of its lower impact on this outcome.

Death or oxygen requirement at 36 weeks' postmenstrual age

380 per 1000

494 per 1000
(395 to 623)

RR 1.30
(1.04 to 1.64)

448
(3 RCTs)

⨁⨁⨁◯
MODERATE 1

Downgraded one level due to imprecision (total number of events does not meet the OIS)

Pneumothorax

63 per 1000

78 per 1000
(45 to 137)

RR 1.24
(0.71 to 2.17)

669
(6 RCTs)

⨁⨁◯◯
LOW 3

Downgraded two levels due to very serious imprecision:

1) the 95% CI includes both no effect and appreciable harm.

2) The total number of events does not meet the optimal information size (OIS to detect a clinically beneficial effect if there is one is > 5000)

Pulmonary hemorrhage

72 per 1000

92 per 1000
(58 to 146)

RR 1.28
(0.81 to 2.02)

871
(8 RCTs)

⨁⨁◯◯
LOW 3

Downgraded two levels due to very serious imprecision:

1) the 95% CI includes both no effect and appreciable harm.

2) The total number of events does not meet the optimal information size (OIS to detect a clinically beneficial effect if there is one is > 5000)

Severe intraventricular hemorrhage in infants who received neuroimaging

97 per 1000

124 per 1000
(80 to 190)

RR 1.28
(0.83 to 1.97)

705
(7 RCTs)

⨁◯◯◯
VERY LOW 4 5

Downgraded three levels due to:

1. Potential risk of bias and 2. serious imprecision: 1) the 95% CI includes both no effect and appreciable harm; and 2) Total number of events does not meet the optimal information size (OIS to detect a clinically beneficial effect if there is one is > 3000)

Neurodevelopmental outcome at approximately two years’ corrected age

see comments

see comments

Not reported in any studies

*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 The total number of events does not meet the OIS

2 95% CI includes benefit, no effect and appreciable harm. Total number of events does not meet the optimal information size.

3 95% CI of the pooled effect crosses 1 and the optimal information size to detect a clinically beneficial effect if there is one is > 5000

4 Studies that carried large weight for the overall effect estimate are classified as high or unclear risk of bias due to lack of blinding in patients, and outcome assessment

5 95% CI of the pooled effect widely crosses 1 and the optimal information size to detect a clinically beneficial effect if there is one is > 3000

Figuras y tablas -
Summary of findings 4. Modified bovine minced lung surfactant extract compared with porcine minced lung surfactant extract in preterm infants for treatment of RDS
Summary of findings 5. Modified bovine minced lung surfactant extract compared with porcine lung lavage surfactant in preterm infants for treatment of RDS

Modified bovine minced lung surfactant extract compared with porcine lung lavage surfactant in preterm infants for treatment of RDS

Patient or population: Preterm infants for treatment of RDS
Setting: Hospital
Intervention: Modified bovine minced lung surfactant extract
Comparison: Porcine lung lavage surfactant

Outcomes

Anticipated absolute effects*

(95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with porcine lung lavage surfactant

Risk with Modified bovine minced lung surfactant extract

Mortality prior to hospital discharge (from any cause)

476 per 1000

524 per 1000
(286 to 948)

RR 1.10
(0.60 to 1.99)

44
(1 RCT)

⨁⨁◯◯
LOW 1

Downgraded two levels due to serious imprecision:

1) The 95% CI includes both no effect and appreciable harm.

2) Total number of events does not meet the optimal information size (OIS to detect a clinically beneficial effect if there is one is > 700).

Oxygen requirement at 36 weeks' postmenstrual age

see comments

see comments

Not reported in any of the studies

Death or oxygen requirement at 36 weeks' postmenstrual age

see comments

see comments

Not reported in any of the studies

Pneumothorax

429 per 1000

43 per 1000
(4 to 313)

RR 0.10
(0.01 to 0.73)

44
(1 RCT)

⨁⨁⨁⨁
HIGH

Pulmonary hemorrhage

see comments

see comments

Not reported in any of the studies

Severe intraventricular hemorrhage in infants who received neuroimaging

see comments

see comments

Not reported in any of the studies

Neurodevelopmental outcome at approximately two years corrected age

see comments

see comments

Not reported in any of the studies

*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 95 % CI of the pooled effect crosses 1 and the optimal information size to detect a clinically beneficial effect if there is one is > 700

Figuras y tablas -
Summary of findings 5. Modified bovine minced lung surfactant extract compared with porcine lung lavage surfactant in preterm infants for treatment of RDS
Comparison 1. Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Neonatal mortality Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Prevention

1

749

Risk Ratio (M‐H, Fixed, 95% CI)

1.19 [0.79, 1.80]

1.2 Treatment

3

1451

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.65, 1.26]

2 Mortality prior to discharge Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Prevention

2

1123

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.90, 1.71]

2.2 Treatment

6

2231

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.79, 1.21]

3 Oxygen requirement at 28 to 30 days of age (all infants) Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Prevention

1

749

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.88, 1.12]

3.2 Treatment

3

1510

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.98, 1.21]

4 Oxygen requirement at 36 weeks postmenstrual age (all infants) Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Prevention

1

749

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.79, 1.19]

4.2 Treatment

5

1564

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.82, 1.11]

5 Death or oxygen requirement at 28 to 30 days of age Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Prevention

1

749

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.93, 1.13]

5.2 Treatment

2

1401

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.96, 1.15]

6 Death or oxygen requirement at 36 weeks postmenstrual age Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 Prevention

2

1123

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.89, 1.17]

6.2 Treatment

3

2009

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.86, 1.06]

7 Received > one dose of surfactant Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Prevention

2

1123

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.89, 1.16]

7.2 Treatment

5

2178

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.93, 1.06]

8 Pneumothorax Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 Prevention

1

749

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.43, 1.36]

8.2 Treatment

6

2224

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.85, 1.51]

9 Air leak syndromes Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 Prevention

2

1123

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.84, 1.60]

9.2 Treatment

3

2022

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.82, 1.28]

10 Pulmonary hemorrhage Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 Prevention

2

1123

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [0.88, 2.39]

10.2 Treatment

4

2138

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.74, 1.59]

11 Treated patent ductus arteriosus (PDA) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

11.1 Treatment

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

0.32 [0.07, 1.34]

12 Culture‐confirmed bacterial sepsis Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

12.1 Prevention

2

1123

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.91, 1.28]

12.2 Treatment

6

2228

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.87, 1.15]

13 Necrotizing enterocolitis (any stage) Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

13.1 Prevention

2

1123

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.74, 1.42]

13.2 Treatment

5

2191

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.78, 1.33]

14 Periventricular leukomalacia Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

14.1 Prevention

1

713

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.29, 1.26]

14.2 Treatment

1

1275

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.59, 1.73]

15 Retinopathy of prematurity in infants examined (all stages) Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

15.1 Prevention

2

1011

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.86, 1.12]

15.2 Treatment

3

1662

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.89, 1.16]

16 Retinopathy of prematurity in infants examined (severe stage 3 or greater) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

16.1 Prevention

1

637

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.77, 1.69]

16.2 Treatment

1

1001

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.64, 1.33]

17 Intraventricular hemorrhage in infants receiving neuroimaging (all grades) Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

17.1 Prevention

1

713

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.87, 1.24]

17.2 Treatment

3

1434

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.98, 1.33]

18 Severe IVH in infants receiving neuroimaging Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

18.1 Prevention

2

1087

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [0.89, 1.83]

18.2 Treatment

5

2040

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.68, 1.09]

Figuras y tablas -
Comparison 1. Bovine lung lavage surfactant extract vs. modified bovine minced lung surfactant extract
Comparison 2. Bovine lung lavage surfactant vs. porcine minced lung

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality prior to discharge Show forest plot

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

1.4 [0.51, 3.87]

2 Oxygen requirement at 36 weeks postmenstrual age Show forest plot

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.19, 3.04]

3 Air leak syndromes Show forest plot

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.12, 3.68]

4 Necrotizing enterocolitis (any stage) Show forest plot

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.12, 3.68]

5 Retinopathy of prematurity in infants examined (all stages) Show forest plot

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.8 [0.24, 2.66]

6 Severe IVH Show forest plot

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.29, 2.41]

Figuras y tablas -
Comparison 2. Bovine lung lavage surfactant vs. porcine minced lung
Comparison 3. Modified bovine minced lung vs. porcine minced lung

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Neonatal mortality Show forest plot

2

320

Risk Ratio (M‐H, Fixed, 95% CI)

1.48 [0.72, 3.07]

2 Mortality prior to discharge Show forest plot

9

901

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [1.04, 2.00]

3 Oxygen requirement at 28 to 30 days of age Show forest plot

2

320

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.77, 1.23]

4 Oxygen requirement at 36 weeks postmenstrual age Show forest plot

9

899

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.79, 1.12]

5 Death or oxygen requirement at 36 weeks postmenstrual age Show forest plot

3

448

Risk Ratio (M‐H, Fixed, 95% CI)

1.30 [1.04, 1.64]

6 Received > one dose of surfactant Show forest plot

6

786

Risk Ratio (M‐H, Fixed, 95% CI)

1.57 [1.29, 1.92]

7 Pneumothorax Show forest plot

6

669

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.71, 2.17]

8 Air leak syndromes Show forest plot

3

255

Risk Ratio (M‐H, Fixed, 95% CI)

2.55 [0.98, 6.68]

9 Pulmonary hemorrhage Show forest plot

8

871

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [0.81, 2.02]

10 Treated patent ductus arteriosus (PDA) Show forest plot

3

137

Risk Ratio (M‐H, Fixed, 95% CI)

1.86 [1.28, 2.70]

11 Culture‐confirmed bacterial sepsis Show forest plot

6

526

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.87, 1.46]

12 Necrotizing enterocolitis (any stage) Show forest plot

7

701

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.50, 1.33]

13 Periventricular leukomalacia Show forest plot

1

47

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.07, 15.72]

14 Retinopathy of prematurity in infants examined (all stages) Show forest plot

3

230

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.29, 1.26]

15 Retinopathy of prematurity in infants examined (severe stage 3 or greater) Show forest plot

4

222

Risk Difference (M‐H, Fixed, 95% CI)

0.00 [‐0.09, 0.09]

16 Intraventricular hemorrhage (all grades) Show forest plot

4

318

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.64, 1.50]

17 Severe IVH Show forest plot

7

705

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [0.83, 1.97]

Figuras y tablas -
Comparison 3. Modified bovine minced lung vs. porcine minced lung
Comparison 4. Modified bovine minced lung vs. porcine lung lavage

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality prior to discharge Show forest plot

1

44

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.60, 1.99]

2 Pneumothorax Show forest plot

1

44

Risk Ratio (M‐H, Fixed, 95% CI)

0.10 [0.01, 0.73]

Figuras y tablas -
Comparison 4. Modified bovine minced lung vs. porcine lung lavage
Comparison 5. Modified bovine minced lung vs. porcine minced lung (based on initial surfactant dosage)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Neonatal mortality Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Initial dose ≤ 100 mg/kg porcine minced lung

2

221

Risk Ratio (M‐H, Fixed, 95% CI)

1.20 [0.55, 2.62]

1.2 Initial dose ˃ 100 mg/kg porcine minced lung

1

197

Risk Ratio (M‐H, Fixed, 95% CI)

2.69 [0.74, 9.86]

2 Mortality prior to discharge Show forest plot

9

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Initial dose ≤ 100 mg/kg porcine minced lung

3

255

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.61, 1.96]

2.2 Initial dose ˃ 100 mg/kg porcine minced lung

7

736

Risk Ratio (M‐H, Fixed, 95% CI)

1.62 [1.11, 2.38]

3 Oxygen requirement at 28 to 30 days of age Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Initial dose ≤ 100 mg/kg porcine minced lung

2

221

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.73, 1.25]

3.2 Initial dose ˃ 100 mg/kg porcine minced lung

1

197

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.76, 1.34]

4 Oxygen requirement at 36 weeks postmenstrual age Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Initial dose ≤ 100 mg/kg porcine minced lung

3

255

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.65, 1.37]

4.2 Initial dose ˃ 100 mg/kg porcine minced lung

6

608

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.84, 1.38]

5 Death or oxygen requirement at 36 weeks postmenstrual age Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Initial dose ≤ 100 mg/kg porcine minced lung

1

175

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.76, 1.43]

5.2 Initial dose ˃ 100 mg/kg porcine minced lung

3

363

Risk Ratio (M‐H, Fixed, 95% CI)

1.39 [1.08, 1.79]

Figuras y tablas -
Comparison 5. Modified bovine minced lung vs. porcine minced lung (based on initial surfactant dosage)