Efficacy Of Pulmonary Surfactant Therapy In Meconium Aspiration Syndrome: A Meta-Analysis

Objective To evaluate the efficacy of pulmonary surfactant(PS) therapy for meconium aspiration syndrome(MAS).Methods Besides manual search, a computer search about PS treat MAS among PubMed, MEDLINE, Science Citation Index (SCI), The Cochrane Central Register of Controlled Trials (CENTRAL), Ovid, EBSCOhost (ASP), BIOSIS previews, CBM, Wanfang database and VIP was performed from the establishment of the database till March 2011. Two evaluators screened the literatures independently. The Cochrane handbook 5.0.2 was used to evaluate methodological quality and RevMan 5.0.25 software was used for meta-analysis.Results Six RCTs were enrolled for meta-analysis and all of them have moderate bias risk. Meta-analysis showed that PS reduced oxygenation index (MD=-2.59, 95%CI:-4.33~-0.86, P=0.003), elevated arterial oxygen/alveolar oxygen ratio (MD=0.05, 95%CI:0.05~0.06, P<0.00001), shortened hospitalization days (MD=-4.94, 95%CI: -7.44 ~-2.44, P=0.0001), and decreased mortality (OR=0.23, 95%CI:0.09 ~0.62, P=0.003) and incidences of air leak(OR=0.33, 95%CI:0.15~0.72, P=0.005) and of intracranial hemorrhage (OR=0.19, 95%CI:0.04~0.94, P=0.04). Bovine surfactant shortened duration of mechanical ventilation (SMD=-2.75, 95%CI -3.36~-2.14, P<0.00001). There were no statistical significances on duration of oxygen therapy, or incidence of pulmonary hemorrhage in groups.Conclusions Surfactant replacement therapy for MAS can improve oxygenation parameters and reduce hospitalization time, mortality, incidence of air leak and intracranial hemorrhage. Bovine surfactant can shorten duration of mechanical ventilation. Because of limited quantity and quality of the trials enrolled in the study, the conclusion is uncertain and further evidences from RCT studies are needed to prove the efficacy of surfactant replacement therapy for MAS.