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Thresholds for surfactant use in preterm neonates: a network meta-analysis

Branagan, A; Yu, I; Gurusamy, K; Miletin, J; (2022) Thresholds for surfactant use in preterm neonates: a network meta-analysis. Archives of Disease in Childhood: Fetal and Neonatal Edition 10.1136/archdischild-2022-324184. (In press). Green open access

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Abstract

Objective: To perform a network meta-analysis of randomised controlled trials of different surfactant treatment strategies for respiratory distress syndrome (RDS) to assess if a certain fraction of inspired oxygen (FiO2) is optimal for selective surfactant therapy. Design: Systematic review and network meta-analysis using Bayesian analysis of randomised trials of prophylactic versus selective surfactant for RDS. Setting: Cochrane Central Register of Controlled Trials, MEDLINE, Embase and Science Citation Index Expanded. Patients: Randomised trials including infants under 32 weeks of gestational age. Interventions: Intratracheal surfactant, irrespective of type or dose. Main outcome measures: Our primary outcome was neonatal mortality, compared between groups treated with selective surfactant therapy at different thresholds of FiO2. Secondary outcomes included respiratory morbidity and major complications of prematurity. Results: Of 4643 identified references, 14 studies involving 5298 participants were included. We found no statistically significant differences between 30%, 40% and 50% FiO2 thresholds. A sensitivity analysis of infants treated in the era of high antenatal steroid use and nasal continuous positive airway pressure as initial mode of respiratory support showed no difference in mortality, RDS or intraventricular haemorrhage alone but suggested an increase in the combined outcome of major morbidities in the 60% threshold. Conclusion: Our results do not show a clear benefit of surfactant treatment at any threshold of FiO2. The 60% threshold was suggestive of increased morbidity. There was no advantage seen with prophylactic treatment. Randomised trials of different thresholds for surfactant delivery are urgently needed to guide clinicians and provide robust evidence. PROSPERO registration number: CRD42020166620.

Type: Article
Title: Thresholds for surfactant use in preterm neonates: a network meta-analysis
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/archdischild-2022-324184
Publisher version: https://doi.org/10.1136/archdischild-2022-324184
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Science & Technology, Life Sciences & Biomedicine, Pediatrics, Intensive Care Units, Neonatal, Neonatology, Respiratory Medicine, POSITIVE AIRWAY PRESSURE, RESPIRATORY-DISTRESS-SYNDROME, PLACEBO-CONTROLLED TRIAL, BIRTH-WEIGHT INFANTS, REPLACEMENT THERAPY, OXYGEN-SATURATION, WEEKS GESTATION, TARGET RANGES, EARLY CPAP, RESCUE
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Surgical Biotechnology
URI: https://discovery.ucl.ac.uk/id/eprint/10164358
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