Surfactant lavage for neonatal meconium aspiration syndrome—An updated meta-analysis

Background: Surfactant lavage seems to have a good application prospect both in experimental models and patients with meconium aspiration syndrome (MAS). Data regarding the effect of surfactant lavage on pulmonary complications of MAS are conflicting. In view of these uncertainties, an updated meta-analysis including the latest literatures is performed. Methods: A search was conducted by two investigators involved in this research in PubMed, Embase, and Cochrane databases for studies in English and other languages, in Wanfang, VIP, and Cnki databases for Chinese studies (all last launched on December 18, 2018). Ultimately, we identified 11 original studies, including the surfactant lavage group (n = 189) and the control group (n = 204). Odds ratio and weighted mean difference were calculated using a random effects or fixed effects model, depending on the data type and heterogeneity of the included studies. Results: The comparison of effectiveness on MAS: (1) With respect to oxygen index at 48 hours stage and 72 hours stage, data showed significant difference between surfactant lavage/control groups (we/ighted mean difference [WMD] = −3.37, 95% confidence interval [CI], −5.68 ~ −1.06; p = 0.004 and 95% CI, −5.03 ~ −2.37; p < 0.00001). (2) With respect to days on mechanical ventilation, the analysis showed that there was significant difference between surfactant lavage group and control group (WMD = −1.12, 95% CI, −1.40 ~ −0.84; p < 0.00001). (3) Regarding the need for extracorporeal membrane oxygenation, days of oxygen therapy, and hospital stay, no significant differences were found. The comparison of possible complications of MAS: (1) Regarding pneumothorax, the analysis showed there was significant difference between surfactant lavage and control groups (odds ratio [OR] = 0.46, 95% CI, 0.24 ~ 0.85; p = 0.01). (2) With respect to mortality, persist pulmonary hypertension and pulmonary hemorrhage, the results showed no difference between the two groups. Conclusion: With respect to oxygen index and days on mechanical ventilation, surfactant lavage is significantly effective compared with control group, though didn’t eventually shorten days of oxygen therapy and hospital stay. In addition, our meta-analysis showed that surfactant lavage does not increase the risk of complications.