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Letter
Critical appraisal of the evidence underpinning the efficacy of less invasive surfactant administration
  1. Stefano Nobile1,
  2. Anthea Bottoni1,
  3. Lucia Giordano1,
  4. Angela Paladini1,
  5. Giovanni Vento1,2
  1. 1Neonatology Unit, Department of Mother, Child and Public Health, Agostino Gemelli University Hospital Foundation IRCCS, Rome, Italy
  2. 2Catholic University of the Sacred Heart, Rome, Italy
  1. Correspondence to Dr Stefano Nobile, Division of Neonatology, Department of Mother, Child and Public Health, Agostino Gemelli University Hospital Foundation IRCCS - Catholic University of the Sacred Heart, Rome 8,00168, Italy; stefano.nobile{at}policlinicogemelli.it

https://doi.org/10.1136/archdischild-2021-323100

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    We read with great interest the network meta-analysis by Bellos and colleagues1 aimed at comparing less invasive surfactant administration (LISA, via thin catheters, laryngeal mask, nebulisation, pharyngeal instillation), intubation and surfactant administration followed by immediate extubation (InSurE) and no surfactant administration among preterm infants born <37 weeks of gestation. Primary outcomes were mortality, mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD). Secondary outcomes were necrotising enterocolitis, intraventricular haemorrhage, pneumothorax, periventricular leukomalacia, patent ductus arteriosus and need of repeat dose of surfactant. The authors included 16 randomised controlled trials (RCTs) and 20 observational studies with overall 13 234 patients. They concluded that surfactant administration via thin catheters was associated with lower likelihood of …

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    Footnotes

    • Collaborators INRECSURE study group.

    • Contributors SN and GV conceived the work, revised it critically for important intellectual content, approved the final version and agree to be accountable for all aspects of the work. AB, LG and AP analysed data, revised it critically for important intellectual content, approved the final version and agree to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    Linked Articles

    • PostScript
      SurE for surfactant: response to letter
      Ioannis Bellos Aakash Pandita
      Archives of Disease in Childhood - Fetal and Neonatal Edition 2021; 108 91-92 Published Online First: 29 Nov 2021. doi: 10.1136/archdischild-2021-323394