Table 1

Baseline characteristics of the included studies

StudyPopulation, settings
Surfactant
Criteria for surfactantLISA groupIntubation groupComments
Göpel et al27GA: 26–28 weeks
Germany, multi-centre
(12 NICUs)
Curosurf/bovine 100 mg/kg
Subjects on nCPAP; and FiO2 ≥0.3 for LISA group and variable Fio2 threshold (between 0.3 and 0.6) for intubation groupN=108
GA: 27.6 (0.8) weeks
Birth weight*: 975 (244) g
2.5–5 Fr catheter
Magill forceps
AS: 96%
N=112
GA: 27.5 (0.8) weeks
Birth Wt: 938 (205) g
InSurE protocol: unclear
AS: 96%
Use of premedication was at the discretion of the attending physicians.
Not all patients received surfactant in either group.
Kanmaz et al28GA: <32 weeks
Turkey, single centre
Curosurf 100 mg/kg
Subjects on nCPAP with FiO2 ≥0.4N=100
GA: 28 (2) weeks
Birth weight: 1093 (270) g
5 Fr feeding tube
AS: 73%
N=100
GA 28.3 (2) weeks
Birth weight: 1121 (270) g
InSurE protocol: yes
AS: 81%
No premedication was used during both procedures.
Mirnia et al29GA: 27–32 weeks
Iran, multi-centre
(3 NICUs)
Curosurf 200 mg/kg
Subjects on nCPAP with FiO2 ≥0.3N=66
GA: 29.6 (1.7) weeks
Birth weight: 1339 (406) g
5 Fr feeding tube
AS: 66.7%
N=70
GA: 29.6 (1.7) weeks
Birth weight: 1304 (331) g
InSurE protocol: yes
AS: 62.9%
Atropine for premedication
Bao et al30GA: 28–32 weeks
China, single centre
Curosurf 200 mg/kg

Subjects on nCPAP with FiO2 ≥0.3 (28–29 weeks) or ≥0.35 (30–32 weeks)N=47
GA: 29.1 (1.5) weeks
Birth weight: 1034 (221) g
16-guage catheter(∼5 Fr)
AS: 89.4%
N=43
GA: 29.3 (1.6) weeks
Birth weight: 1087 (198) g
InSurE protocol: yes
AS: 93%
Mohammadizadeh et al31GA: <34 weeks
Iran, multi-centre
(2 NICUs)
Curosurf 200 mg/kg
Subjects on nCPAP with FiO2 ≥0.3 or moderate-to-severe RDS (Silverman score ≥5)N=19
GA: 30 (2) weeks
Birth weight: 1289 (219) g
4 Fr feeding tube
Magill forceps
AS: 84.2%
N=19
GA 31 (2) weeks
Birth weight: 1428 (272) g
InSurE protocol: yes
AS: 89.5%
Atropine for premedication
Kribs et al32GA: 23 to <27 weeks
Germany, multi-centre
(13 NICUs)
Curosurf 100 mg/kg
Subjects on nCPAP with FiO2 ≥0.3 or moderate-to-severe RDS (Silverman score ≥5)N=107
GA: 25.3 (1.1) weeks
Birth weight: 711 (195) g
4 Fr catheter
Magill forceps
AS: 98.1%
N=104
GA: 25.2 (0.91) weeks
Birth weight: 674 (165) g
InSurE protocol: no
(centres were advised to extubate as soon as possible)
AS: 98.1%
Use of premedication was not specified.
  • *Data are mean (SD) for all studies.

  • AS, antenatal steroids; Fio2, fractional inspired oxygen; GA, gestational age; InSurE, Intubation, Surfactant and Extubation; LISA, less invasive surfactant administration; NICU, neonatal intensive care unit; RDS, respiratory distress syndrome.