MORTALITY, SEVERE RESPIRATORY-DISTRESS SYNDROME, AND CHRONIC LUNG-DISEASE OF THE NEWBORN ARE REDUCED MORE AFTER PROPHYLACTIC THAN AFTER THERAPEUTIC ADMINISTRATION OF THE SURFACTANT CUROSURF
J. Egberts et al., MORTALITY, SEVERE RESPIRATORY-DISTRESS SYNDROME, AND CHRONIC LUNG-DISEASE OF THE NEWBORN ARE REDUCED MORE AFTER PROPHYLACTIC THAN AFTER THERAPEUTIC ADMINISTRATION OF THE SURFACTANT CUROSURF, Pediatrics, 100(1), 1997, pp. 41-46
Objective. To test the hypothesis that prophylactic treatment with the
surfactant Curosurf (Chiesi Farmaceutici SPA, Parma, Italy) improves
survival and respiratory problems more than rescue treatment. Design.
Meta-analysis of three prophylaxis versus rescue treatment trials, con
ducted in four countries. Methods. A meta-analysis was performed with
the original, individual data of mortality, severe respiratory distres
s syndrome, and chronic lung disease of 671 newborns as outcomes. The
random-effects logistic model (accounting for the trial-within-country
structure) was applied and adjusted for imbalances in covariates. Res
ults. The probability of each outcome differed between the countries,
but the actual treatment effect itself did not. The adjusted odds rati
os (ORs) and confidence intervals (CIs) for prophylaxis versus rescue
were as follows: mortality: OR, .47; 95% CI, .30 to .73; severe RDS: O
R, .50; 95% CI, .33 to .74; and chronic lung disease of the newborn in
the survivors at day 28 after birth: OR, .54; 95% CI, .34 to .86. Gen
der, birth weight, gestational age, and prenatal administration of glu
cocorticosteroids were significant confounding covariates. Conclusion.
The analysis shows that for the porcine surfactant Curosurf, prophyla
ctic administration of surfactant has significant advantages over resc
ue therapy.