Safety and efficacy of pulmonary surfactant therapy for acute respiratory distress syndrome in children: a systematic review and meta-analysis.

Abstract

Objective: Pulmonary surfactants (PSs) are generally known to be effective in treating newborns with acute respiratory distress syndrome (ARDS). However, their effectiveness in children remains controversial. The purpose of the current systematic review and meta-analysis was to assess the effectiveness and safety of PS in children.

Methods: A comprehensive search of the PubMed, EMBASE, Cochrane, CNKI, and Wanfang databases was conducted to identify publications up to December 2024. Only multicenter, randomized controlled trials involving children aged between 1 month and 18 years with acute lung injury or ARDS were included. The intervention group received PS treatment, whereas the control group received a placebo. The primary outcome measure was mortality rate, and secondary outcomes included days without mechanical ventilation, duration of mechanical ventilation, incidence of adverse events, and oxygenation index (OI).

Results: Seven articles met the inclusion criteria. The use of PS was associated with a significant reduction in the mortality rate (relative risk [RR] = 1.50, 95% confidence interval [CI] = 1.11-2.01, p = 0.008). In terms of secondary outcomes, there was an increase in the number of days without mechanical ventilation (mean difference = 1.20, 95% CI = 0.24-2.15, p = 0.01) and a lower incidence of adverse events (RR = 1.76, 95% CI = 1.14 to 2.71, p = 0.01) in the intervention group than in the control group, with no significant difference in mechanical ventilation duration (MD = -1.06, 95% CI = -3.47 to -1.35, p = 0.39) or OI (MD = -0.65, 95% CI = -3.48 to -2.19, p = 0.66).

Conclusion: PS treatment was associated with a reduction in the mortality rate and incidence of adverse events in critically ill children with ARDS; however, the clinical impact of PS treatment warrants further research.

Trial registration: Not applicable.