Digoxin for preventing or treating neonatal respiratory distress syndrome.
Author(s): Soll R, Ozek E.
Affiliation(s): Division of Neonatal-Perinatal Medicine, University of Vermont, Fletcher Allen
Health Care, Smith 552A, 111 Colchester Avenue, Burlington, Vermont, USA, 05401.
Publication date & source: 2011, Cochrane Database Syst Rev. , (1):CD001080
BACKGROUND: Lendrum 1955 suggested that pulmonary edema secondary to congestive
heart failure may contribute to neonatal respiratory distress syndrome (RDS).
Based on this hypothesis, investigators began to use digitalis glycosides to
improve myocardial contractility and decrease congestive heart failure. The first
use of digitalis glycosides in infants with RDS was reported by Stahlman 1959.
Stahlman reported a reduction in mortality in an uncontrolled trial of digitalis
in infants with RDS.
OBJECTIVES: To assess the effect of digoxin on mortality in premature infants at
risk for or with RDS.
SEARCH STRATEGY: Searches were made of the Oxford Database of Perinatal Trials,
Medline (MeSH terms: digoxin; limits: age groups, newborn infants; publication
type, clinical trial), previous reviews including cross references, abstracts,
conference and symposia proceedings, expert informants, and journal handsearching
in the English language.When updated in December 2008, the search was expanded to
include Medline, CINHAL, and Embase (MeSH terms and text words: digoxin or
digitalis; limits: age group, all infants; publication type: clinical trial).
SELECTION CRITERIA: Randomized and quazi-randomized controlled trials of digoxin
in either the prevention or treatment of RDS are included in this overview.
DATA COLLECTION AND ANALYSIS: Data regarding clinical outcomes were excerpted
from the trial reports by one review author (RS) and checked by the second review
author (EO). Data were analyzed according to the standards of the Cochrane
Neonatal Review Group.
MAIN RESULTS: Two randomized controlled trials have studied the effects of
digoxin in the prevention and treatment of RDS. No improvement in respiratory
status or mortality was noted. Meta-analysis of the effect of digoxin given to
infants at risk of or with RDS on mortality does not suggest any benefit of
digoxin treatment (typical relative risk 1.27 95% CI 0.78 to 2.07; typical risk
difference 0.06, 95% CI -0.06 to 0.17).
AUTHORS' CONCLUSIONS: Although hemodynamic disturbances play a role in the
overall pathogenesis of respiratory distress syndrome, the specific contribution
of early congestive heart failure (unrelated to hemodynamically significant
patent ductus arteriosus) does not appear to be a significant factor in RDS.
Treatment with digoxin has no proven value in infants solely affected with RDS.
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