We congratulate Sehgal and colleagues for their study (1) that found
prophylactic surfactant causes major haemo-dynamic changes in preterm
babies. This publication follows close on the heels of a study in the NEJM
that found that prophylactic surfactant was no better than continuous
positive airway pressure (CPAP)ventilation (2). It is significant that
both these papers (1,2) quote a Cochrane meta-analysis in there
introduction to suggest that prophylactic surfactant reduces mortality
(3). This is a misinterpretation of the Cochrane report. The meta-analysis
had found that there was no difference in the in-hospital deaths, after
use of surfactant (Risk Ratio: 0.70, 95% C.I. 0.47 - 1.06). It however
found that surfactant reduces incidence of deaths in the first 30 days of
life and this was then reported as a reduction in neonatal mortality (Risk
Ratio: 0.80, C.I. 0.72 - 0.88). The Cochrane meta-analysis was revised
recently (4) but this misleading statement in the abstract has survived
into the new version also. The fact that leading researchers working with
surfactant carry this wrong impression from the Cochrane report suggests
that the report needs to be revised for clarity.
We hope that this letter will in a small way, add to the results of newer
studies on surfactant(1,2), to clarify the issue that prophylactic
surfactant is not useful in reducing mortality.
References
1. Haemodynamic changes after delivery room surfactant administration
to very low birth weight infants Arvind Sehgal, Wendy Mak, Michael Dunn,
Edmond Kelly, Hilary Whyte, B McCrindle, Patrick J McNamara Arch. Dis.
Child. Fetal Neonatal Ed. published 10 June 2010, 10.1136/adc.2009.173724
2. SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal
Research Network. Early CPAP versus Surfactant in Extremely Preterm
Infants. N Engl J Med. 2010 May 16. [Epub ahead of print] PMID: 20472939
3. Soll RF. Prophylactic natural surfactant extract for preventing
morbidity and mortality in preterm infants. Cochrane Database Syst Rev
2000;2:CD000511.
4. Soll R, Ozek E. Prophylactic animal derived surfactant extract for
preventing morbidity and mortality in preterm infants. Cochrane Database
of Systematic Reviews 1997, Issue 4. Art. No.: CD000511. DOI:
10.1002/14651858.CD000511
Conflict of Interest:
None declared
We congratulate Sehgal and colleagues for their study (1) that found prophylactic surfactant causes major haemo-dynamic changes in preterm babies. This publication follows close on the heels of a study in the NEJM that found that prophylactic surfactant was no better than continuous positive airway pressure (CPAP)ventilation (2). It is significant that both these papers (1,2) quote a Cochrane meta-analysis in there introduction to suggest that prophylactic surfactant reduces mortality (3). This is a misinterpretation of the Cochrane report. The meta-analysis had found that there was no difference in the in-hospital deaths, after use of surfactant (Risk Ratio: 0.70, 95% C.I. 0.47 - 1.06). It however found that surfactant reduces incidence of deaths in the first 30 days of life and this was then reported as a reduction in neonatal mortality (Risk Ratio: 0.80, C.I. 0.72 - 0.88). The Cochrane meta-analysis was revised recently (4) but this misleading statement in the abstract has survived into the new version also. The fact that leading researchers working with surfactant carry this wrong impression from the Cochrane report suggests that the report needs to be revised for clarity. We hope that this letter will in a small way, add to the results of newer studies on surfactant(1,2), to clarify the issue that prophylactic surfactant is not useful in reducing mortality.
References
1. Haemodynamic changes after delivery room surfactant administration to very low birth weight infants Arvind Sehgal, Wendy Mak, Michael Dunn, Edmond Kelly, Hilary Whyte, B McCrindle, Patrick J McNamara Arch. Dis. Child. Fetal Neonatal Ed. published 10 June 2010, 10.1136/adc.2009.173724
2. SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Early CPAP versus Surfactant in Extremely Preterm Infants. N Engl J Med. 2010 May 16. [Epub ahead of print] PMID: 20472939
3. Soll RF. Prophylactic natural surfactant extract for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2000;2:CD000511.
4. Soll R, Ozek E. Prophylactic animal derived surfactant extract for preventing morbidity and mortality in preterm infants. Cochrane Database of Systematic Reviews 1997, Issue 4. Art. No.: CD000511. DOI: 10.1002/14651858.CD000511
Conflict of Interest:
None declared