Early regular versus late selective poractant treatment in preterm infants born between 25 and 30 gestational weeks: a prospective randomized multicenter study

Dilmen, Uğur; Оздемир, Рамазан; Aksoy, Hatice Tatar; Uraş, Nurdan; Demirel, Nihal; Kırımi, Ercan; Erdeve, Ömer; Özer, Esra Arun; Baş, Ahmet Yağmur; Gürsoy, Tuğba; Zencıroğlu, Ayşegül; Ovalı, Fahri; Oğuz, Şerife Suna

doi:10.3109/14767058.2013.818120

Cited by 11 publications

(15 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The searches of the electronic databases and gray literature identified 1761 nonduplicate records, among which 62 articles were selected for full-text review ( Figure 1) and 9 trials met the inclusion criteria, [27][28][29][30][31][32][33][34][35] with a total of 1551 preterm infants. The agreement of the study selection between the 2 reviewers was excellent, with a κ of 0.828 and a raw agreement of 95.2%.…”

Section: Resultsmentioning

confidence: 99%

“…Because all the outcomes were objective, the detection bias attributable to the lack of masking was considered low risk for most of the outcomes except for CLD, whose diagnoses might be affected by the different criteria of oxygen administration among physicians. 36 The data for CLD in the study by Dilmen et al 27 and for severe intraventricular hemorrhage in the study by Verder et al 35 were judged as being at high risk of attrition bias due to missing data (>10%). Two studies 34,35 were stopped early for significant findings that may overestimate intervention effects 37 and, hence, were considered at high risk of bias.…”

Section: Assessment Of Risk Of Biasmentioning

confidence: 99%

See 1 more Smart Citation

Noninvasive Ventilation With vs Without Early Surfactant to Prevent Chronic Lung Disease in Preterm Infants

2015

View full text Add to dashboard Cite

IMPORTANCE Controversy exists regarding which of the 2 major strategies currently used to prevent chronic lung disease (CLD) in preterm infants is optimal: noninvasive continuous positive airway pressure (NCPAP) or intubate-surfactant-extubate (INSURE). Preterm infants often require surfactant administration because of respiratory distress syndrome.OBJECTIVE To evaluate whether early INSURE or NCPAP alone is more effective in preventing CLD, death, or both.DATA SOURCES We searched the MEDLINE, EMBASE, Cochrane Controlled Trials Register, and Cumulative Index to Nursing and Allied Health Literature databases from their inception to January 2, 2015, along with conference proceedings and trial registrations.STUDY SELECTION Randomized clinical trials that compared early INSURE with NCPAP alone in preterm infants who had never been intubated before the study entry were selected. Among 1761 initially identified articles, 9 trials (1551 infants) were included. DATA EXTRACTION AND SYNTHESISDuplicate study selection and data extraction were performed. Meta-analysis was conducted using random-effects models with quality-of-evidence assessment according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. MAIN OUTCOMES AND MEASURESSeven main outcomes were selected a priori to be assessed according to GRADE, including a composite outcome of CLD and/or death, CLD alone, death alone, air leakage, severe intraventricular hemorrhage, neurodevelopmental impairment, and a composite outcome of death and/or neurodevelopmental impairment. RESULTS There were no statistically significant differences between early INSURE and NCPAP alone for all outcomes assessed. However, the relative risk (RR) estimates appeared to favor early INSURE over NCPAP alone, with a 12% RR reduction in CLD and/or death (RR, 0.88; 95% CI, 0.76-1.02; risk difference [RD], −0.04; 95% CI, −0.08 to 0.01; moderate quality of evidence), a 14% decrease in CLD (RR, 0.86; 95% CI, 0.71-1.03; RD, −0.03; 95% CI, −0.06 to 0.01; moderate quality of evidence), and a 50% decrease in air leakage (RR, 0.50; 95% CI, 0.24-1.07; RD, −0.03; 95% CI, −0.06 to 0.00; very low quality of evidence). The sample size was less than the optimal information size.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Assessment Of Risk Of Biasmentioning

confidence: 99%

Noninvasive Ventilation With vs Without Early Surfactant to Prevent Chronic Lung Disease in Preterm Infants

2015

View full text Add to dashboard Cite

show abstract

“…With regard to avoiding eMV, nine RCTs were included. These RCTs compared various strategies of nCPAP with or without surfactant administration via a thin catheter versus strategies that prescribed INSURE or longer-term eMV and surfactant (table 2) [13,[21][22][23][24][25][26][27][28].…”

Section: Included Studiesmentioning

confidence: 99%

“…Only two RCTs in the sustained inflations meta-analysis prescribed a blinded outcome assessment (low risk/detection bias) [12,20]. Minor issues in several studies were the incomplete description of random sequence generation (unclear risk/selection bias) [17-19, 23, 24, 27], late or no registration of the study protocol (unclear risk/reporting bias) [11,18,19,22,27,28], and the use of respiratory distress as a study entry criterion (unclear risk/sampling bias) [13,21,22,26,28]. Other risks of bias in individual studies and the support for the current review authors' judgements are described in the supplementary material.…”

Section: Risk Of Bias In the Included Studiesmentioning

confidence: 99%

Sustained inflations and avoiding mechanical ventilation to prevent death or bronchopulmonary dysplasia: a meta-analysis

et al. 2018

View full text Add to dashboard Cite

Sustained inflations and avoidance of endotracheal mechanical ventilation (eMV) are delivery room interventions aimed at preventing bronchopulmonary dysplasia (BPD). Their effectiveness is the subject of the present meta-analysis.The databases MEDLINE, EMBASE and CENTRAL were searched for randomised controlled trials (RCTs) of preterm infants that compared: 1) sustained inflations with intermittent positive-pressure ventilation; and 2) a non-intubated strategy of respiratory support with one that prescribed eMV at an earlier stage. Data extraction and analysis followed the standard methods of the Cochrane Collaboration. The primary outcome was death or BPD, defined as need for oxygen or positive pressure treatment at 36 weeks' postmenstrual age.Avoiding eMV (nine RCTs, 3486 infants) reduced the risk of death or BPD, with a risk ratio of 0.90 (95% CI 0.84–0.97) and a number needed to treat of 35. After sustained inflations (six RCTs, 854 infants), the risk ratio was 0.85 (95% CI 0.65–1.12). A current multicentre RCT of sustained inflations in very preterm infants was halted for increased early mortality in the sustained inflations arm.While strategies aimed at avoiding eMV had a small but significant impact on preventing BPD, sustained inflations had no effect and may even increase mortality in very preterm infants.

show abstract

“…4,5 However, recent meta-analysis have shown that this practice of prophylactic use of surfactant is no more superior to early selective treatment with surfactant as soon as the clinical signs of RDS appear. [6][7][8][9] A major long term morbidity of premature birth is Bronchopulmonary dysplasia which is defined as a need for supplemental oxygen or ventilatory support at 36 weeks post last menstrual period (LMP). This is a clinical sequela of prolonged ventilation as a result of abnormal reparative processes in response to injury and inflammation.…”

mentioning

confidence: 99%

Morbidity and mortality pattern of very low birth weight and extremely low birth weight neonates in a tertiary care hospital

Hussain

Jan

Abbas

et al. 2019

Int J Contemp Pediatr

View full text Add to dashboard Cite

Background: Although the mortality and morbidity rates for Very Low Birth Weight (VLBW) and Extremely Low Birth Weight (ELBW) neonates have improved over last few decades, they still remain highly vulnerable groups. This study determines the neonatal morbidity and mortality within first four weeks of life in VLBW and ELBW neonates.Methods: It was a hospital based prospective study conducted in the department of paediatrics at GB Pant hospital, an associated hospital of Government Medical College Srinagar. All included neonates were evaluated in neonatology section and were followed up to 4 weeks of life. Standard protocols were used for management of these neonates.Results: A total of 116 neonates were included in the study. Among the 116 neonates 82 (70.69%) were VLBW and 34 (29.31%) were ELBW. 28 (34.14%) VLBW and 18 (52.94%) ELBW neonates died. Among the morbidities Respiratory Distress Syndrome was found in 35.37% of VLBW and 70.59% of ELBW neonates, out of which 12.20% VLBW and 20.58% ELBW neonates developed Bronchopulmonary dysplasia. Perinatal asphyxia was found in 20.73% of VLBW and 29.41% of ELBW neonates and Pathological apnea occurred in 28.04% VLBW and 85.29% ELBW neonates. 40.24% VLBW and 73.53% ELBW neonates developed clinically significant jaundice requiring treatment. Clinical sepsis was found in 43.90% VLBW and 67.65% ELBW neonates while as culture proven sepsis was found in 26.83% VLBW and 41.18% ELBW neonates. Intra ventricular haemorrhage was found in 15.85% VLBW and 52.94% ELBW neonates. Necrotizing enterocolitis developed in 18.29% VLBW and 35.29% ELBW neonates. Retinopathy of prematurity was found in 21.95% VLBW and 26.47% ELBW neonates. Patent ductus arteriosus was found in 14.63% VLBW and 32.35% ELBW neonates.Conclusions: Present study has shown Respiratory distress syndrome, perinatal asphyxia and sepsis as the predominant causes of neonatal morbidity and mortality and these are preventable with a proper health care system and policy directed to the primary prevention.

show abstract

Early regular versus late selective poractant treatment in preterm infants born between 25 and 30 gestational weeks: a prospective randomized multicenter study

Abstract: ES treatment decreases IVH (≥ grade III) and pneumothorax rates but does not have any effect on BPD when compared to LS.

Cited by 11 publications

References 17 publications

Noninvasive Ventilation With vs Without Early Surfactant to Prevent Chronic Lung Disease in Preterm Infants

Noninvasive Ventilation With vs Without Early Surfactant to Prevent Chronic Lung Disease in Preterm Infants

Sustained inflations and avoiding mechanical ventilation to prevent death or bronchopulmonary dysplasia: a meta-analysis

Morbidity and mortality pattern of very low birth weight and extremely low birth weight neonates in a tertiary care hospital

Contact Info

Product

Resources

About