Villasís-Keever MÁ, Rendón-Macías ME, García HJ, Escamilla-Núñez A, Salinas-Escudero G, Martínez-Valverde S, Garduño-Espinosa J, Muñoz-Hernández O

Idioma: Español
Referencias bibliográficas: 31
Paginas: 477-491
Archivo PDF: 510.13 Kb.

RESUMEN

Introducción. Con el propósito de determinar la efectividad del surfactante bovino (SB) para el tratamiento del síndrome de dificultad respiratoria (SDR) en recién nacidos prematuros (RNP), se realizó una revisión sistemática y meta-análisis.
Métodos. Se incluyeron ensayos clínicos aleatorizados (ECA) donde se comparó SB con placebo. Las variables de desenlace fueron: mortalidad, morbilidad, días de ventilación mecánica (VM) y de estancia hospitalaria. Los ECA publicados hasta el 2010 se identificaron en Medline, EMBASE y la Colaboración Cochrane. La selección de los ECA fue por pares. En el meta-análisis se calculó riesgo relativo (RR) y diferencia de medias ponderada (DMP), con intervalos de confianza al 95% (IC95%).
Resultados. De 865 títulos y resúmenes, se revisaron 89 artículos en extenso y se seleccionaron 12 ECA. El SB se mostró efectivo en cuatro variables: mortalidad (RR 0.73, IC95% 0.60–0.88, P =0.001), neumotórax (RR 0.41; IC95% 0.33–0.51, P ‹0.0001), enfisema intersticial pulmonar (RR 0.45; IC95% 0.36–0.56, P ‹0.0001) y días de VM (DMP -9.57; IC95% -16.58, -2.56, P =0.007). Para otras, como displasia broncopulmonar, enterocolitis necrosante, hemorragia intraventricular o alteración del desarrollo neurológico, no se determinó ventaja con SB.
Conclusiones. En RNP, el uso de SB es efectivo al disminuir la mortalidad, la frecuencia de neumotórax y enfisema intersticial pulmonar, así como el tiempo de VM y, posiblemente, el de estancia hospitalaria.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Sweet D, Bevilacqua G, Carnielli V, Greisen G, Plavka R, Saugstad OD, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome. J Perinat Med 2007;35:175-186.

2. Jobe AH. Lung maturation: the survival miracle of very low birth weight infants. Pediatr Neonatol 2010;51:7-13.

3. Logan JW, Moya FR. Animal-derived surfactants for the treatment and prevention of neonatal respiratory distress syndrome: summary of clinical trials. Ther Clin Risk Manag 2009;5:251-260.

4. Obladen M. History of surfactant up to 1980. Biol Neonate 2005;87:308-316.

5. Halliday HL. History of surfactant from 1980. Biol Neonate 2005;87:317-322.

6. Halliday HL. Surfactants: past, present and future. J Perinatol 2008;28(Suppl 1):S47-S56.

7. Engle WA, American Academy of Pediatrics Committee on Fetus and Newborn. Surfactant-replacement therapy for respiratory distress in the preterm and term neonate. Pediatrics 2008;121:419-432.

8. Kresch MJ, Clive JM. Meta-analyses of surfactant replacement therapy of infants with birth weights less than 2000 grams. J Perinatol 1998;18:276-283.

9. Ramanathan R. Animal-derived surfactants: where are we? The evidence from randomized, controlled clinical trials. J Perinatol 2009;29(Suppl 2):S38-S43.

10. Seger N, Soll R. Animal derived surfactant extract for treatment of respiratory distress syndrome. Cochrane Database Syst Rev 2009;2:CD007836. Available at: http://www2.cochrane.org/reviews/en/ab007836.html

11. Soll R, Özek E. Multiple versus single doses of exogenous surfactant for the prevention or treatment of neonatal respiratory distress syndrome. Cochrane Database Syst Rev 2009;1:CD000141. Available at: http://www2.cochrane.org/reviews/en/ab000141.html

12. Sánchez-Mendiola M, Martínez-Natera OC, Herrera-Maldonado N, Ortega-Arroyo J. Estudio controlado del tratamiento de la enfermedad de membrana hialina del recién nacido pretérmino con surfactante pulmonar exógeno (porcino vs. bovino). Gac Méd Méx 2005;141:267-271.

13. Rojas MA, Lozano JM, Rojas MX, Laughon M, Bose CL, Rondon MA, et al. Very early surfactant without mandatory ventilation in premature infants treated with early continuous positive airway pressure: a randomized, controlled trial. Pediatrics 2009;123:137-142.

14. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1-12.

15. Gitlin JD, Soll RF, Parad RB, Horbar JD, Feldman HA, Lucey JF, et al. Randomized controlled trial of exogenous surfactant for treatment of hyaline membrane disease. Pediatrics 1987;79:31-37.

16. Ware J, Taeusch HW, Soll RF, McCormick MC. Health and developmental outcomes of a surfactant controlled trial: follow-up at 2 years. Pediatrics 1990;85:1103-1107.

17. Raju TN, Vidyasagar D, Bhat R, Sobel D, McCulloch KM, Anderson M, et al. Double-blind controlled trial of single-dose treatment with bovine surfactant in severe hyaline membrane disease. Lancet 1987;21:651-656.

18. Soll RF, Duc G, Minoli T, Vermosld H, Riegel K, Schachinger H. European study of single dose surfactant TA (STA) for treatment of respiratory distress syndrome (RDS). Pediatr Res 1988;23:525A.

19. Horbar JD, Soll RF, Sutherland JM, Kotagal U, Philip AGS, Kessler DL, et al. A multicenter randomized, placebo-controlled trial of surfactant therapy for respiratory distress syndrome. N Eng J Med 1989;320:959-965.

20. Horbar JD, Soll RF, Schachinger H, Kewitz G, Versmold HT, Lindner W, et al. A European multicenter randomized controlled trial of single dose surfactant therapy for idiopathic respiratory distress syndrome. Eur J Pediatr 1990;149:416-423.

21. Dunn MS, Shennan A, Possmayer F. Single- versus multiple-dose surfactant replacement therapy in neonates of 30 to 36 weeks’ gestation with respiratory distress syndrome. Pediatrics 1990;86:564-571.

22. Fujiwara T, Konishi M, Chida S, Okuyama K, Ogawa Y, Takeuchi Y, et al. Surfactant replacement therapy with a single postventilatory dose of a reconstituted bovine surfactant in preterm neonates with respiratory distress syndrome: final analysis of a multicenter, double-blind randomized trial and comparison with similar trials. Pediatrics 1990;86:753-764.

23. Chen JY. Exogenous surfactant for treatment of respiratory distress syndrome in prematures infants. J Formos Med Assoc 1990;89:110-114.

24. Dunn MS, Shennan AT, Zayack D, Possmayer F. Bovine surfactant replacement therapy in neonates of less than 30 weeks’ gestation: a randomized controlled trial of prophylaxis versus treatment. Pediatrics 1991;87:377-396.

25. Liechty EA, Donovan E, Purohit D, Gilhooly J, Feldman B, Noguchi A, et al. Reduction of neonatal mortality after multiple doses of bovine surfactant in low birth weight neonates with respiratory distress syndrome. Pediatrics 1991;88:19-28.

26. Gortner L, Bernsau U, Hellwege HH, Hieronimi G, Jorch G, Reiter HL. A multicenter randomized controlled clinical trial of bovine surfactant for prevention of respiratory distress syndrome. Lung 1990;168(Suppl):864-869.

27. Gortner L, Bartmann P, Pohlandt F, Bernsau U, Porz F, Hellwege HH, et al. Early treatment of respiratory distress syndrome with bovine surfactant in very preterm infants: a multicenter controlled clinical trial. Pediatr Pulmonol 1992;14:4-9.

28. Dani C, Barp J, Berti E, Bertini G. Surfactant in the preterm infant: what’s going on. J Matern Fetal Neonatal Med 2009;22(Suppl 3):3-5.

29. Mugford M. Cost effectiveness of prevention and treatment of neonatal respiratory distress (RDS) with exogenous surfactant: what has changed in the last three decades? Early Hum Dev 2006;82:105-115.

30. Jasso-Gutiérrez L, Mejía-Aranguré JM. Evaluación del tratamiento con surfactante en el síndrome de dificultad respiratoria. El aporte de diferentes metaanálisis. Bol Med Hosp Infant Mex 1998;55:468-476.

31. Moher D, Cook DJ, Jadad AR, Tugwell P, Moher M, Jones A, et al. Assessing the quality of reports of randomized trials: implications for the conduct of meta-analyses. Health Technol Assess 1999;3:1-98.