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Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis
  1. Jose C Aldana-Aguirre1,
  2. Merlin Pinto1,
  3. Robin M Featherstone2,
  4. Manoj Kumar1,3
  1. 1Neonatal Division, Department of Pediatrics, University of Alberta, Edmonton, Canada
  2. 2Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Canada
  3. 3Alberta Health Services, Edmonton, Canada
  1. Correspondence to Dr Manoj Kumar, Department of Pediatrics, Edmonton Clinical Health Academy, Room 3-528, 11405 87 Avenue NW, Edmonton, Alberta, Canada T6G 1C9; manojk{at}ualberta.ca

Abstract

Context In spontaneously breathing preterm infants with respiratory distress syndrome (RDS) receiving nasal continuous positive airway pressure, a method of less invasive surfactant administration (LISA) using a thin catheter has been described as an alternative to endotracheal intubation for surfactant delivery to reduce lung injury.

Objective A systematic review of randomised controlled trials (RCTs) comparing LISA with the standard method of surfactant delivery for clinical outcomes.

Methods Medline, CENTRAL and Embase databases were searched (until 29 October 2015). Additional citations were identified from trial registries, conference proceedings and the bibliographies of selected articles. The included studies were RCTs enrolling preterm infants with RDS and compared LISA technique with intubation for surfactant delivery for any of the prespecified clinical outcomes.

Results Six RCTs were identified, enrolling a total of 895 infants. The use of LISA technique reduced the composite outcome of death or bronchopulmonary dysplasia (BPD) at 36 weeks (risk ratio (RR)=0.75 (95% CI 0.59 to 0.94), p=0.01), BPD36 among survivors (RR=0.72 (0.53 to 0.97), p=0.03), need for mechanical ventilation within 72 hours of birth (RR=0.71 (0.53 to 0.96), p=0.02) or need for mechanical ventilation anytime during the neonatal intensive care unit stay (RR=0.66 (0.47 to 0.93), p=0.02). There were no differences noted for the outcome of death and other neonatal morbidities. Procedure failure rate on the first attempt and the need for additional doses of surfactant were not different between the intervention groups.

Conclusions LISA technique for surfactant delivery results in a lesser need for mechanical ventilation in infants with RDS, reduction in the composite outcome of death or BPD at 36 weeks, and BPD36 among survivors.

  • less invasive surfactant administration
  • systematic review
  • InSurE
  • respiratory distress syndrome
  • meta-analysis

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Footnotes

  • Contributors JCA-A contributed to all stages of the review, wrote the first draft of the manuscript and approved the final manuscript as submitted. MP contributed to the planning of the study, literature search, data extraction and risk of bias assessments, and approved the final manuscript as submitted. RMF contributed to the planning of the study and literature search, and approved the final manuscript as submitted. MK contributed to all stages of the review, reviewed all drafts of the manuscript and approved the final manuscript as submitted.

  • Competing interests None declared.

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