TY - JOUR T1 - Thresholds for surfactant use in preterm neonates: a network meta-analysis JF - Archives of Disease in Childhood - Fetal and Neonatal Edition JO - Arch Dis Child Fetal Neonatal Ed DO - 10.1136/archdischild-2022-324184 SP - fetalneonatal-2022-324184 AU - Aoife Branagan AU - Ivan Yu AU - Kurinchi Gurusamy AU - Jan Miletin Y1 - 2022/12/09 UR - http://fn.bmj.com/content/early/2023/02/20/archdischild-2022-324184.abstract N2 - Objective To perform a network meta-analysis of randomised controlled trials of different surfactant treatment strategies for respiratory distress syndrome (RDS) to assess if a certain fraction of inspired oxygen (FiO2) is optimal for selective surfactant therapy.Design Systematic review and network meta-analysis using Bayesian analysis of randomised trials of prophylactic versus selective surfactant for RDS.Setting Cochrane Central Register of Controlled Trials, MEDLINE, Embase and Science Citation Index Expanded.Patients Randomised trials including infants under 32 weeks of gestational age.Interventions Intratracheal surfactant, irrespective of type or dose.Main outcome measures Our primary outcome was neonatal mortality, compared between groups treated with selective surfactant therapy at different thresholds of FiO2. Secondary outcomes included respiratory morbidity and major complications of prematurity.Results Of 4643 identified references, 14 studies involving 5298 participants were included. We found no statistically significant differences between 30%, 40% and 50% FiO2 thresholds. A sensitivity analysis of infants treated in the era of high antenatal steroid use and nasal continuous positive airway pressure as initial mode of respiratory support showed no difference in mortality, RDS or intraventricular haemorrhage alone but suggested an increase in the combined outcome of major morbidities in the 60% threshold.Conclusion Our results do not show a clear benefit of surfactant treatment at any threshold of FiO2. The 60% threshold was suggestive of increased morbidity. There was no advantage seen with prophylactic treatment. Randomised trials of different thresholds for surfactant delivery are urgently needed to guide clinicians and provide robust evidence.PROSPERO registration number CRD42020166620.Data are available upon reasonable request. Data is available on reasonable request to the authors. ER -