Title:Thin-catheter Surfactant Application for Respiratory Distress Syndrome
in Spontaneously Breathing Preterm Infants: A Meta-analysis of Randomized
Clinical Trials
Volume: 18
Issue: 4
Author(s): Hanan Kesler, Klaus Lohmeier, Thomas Hoehn, Angela Kribs and Frank Peinemann*
Affiliation:
- Children's Hospital, University Hospital of Cologne, Cologne, Germany
- FOM University of Applied Science for Economics & Management, Essen, Germany
Keywords:
Infant, premature, pulmonary surfactants, respiratory distress syndrome, bronchopulmonary dysplasia, systematic review, meta-analysis.
Abstract:
Background: Surfactant application by a thin catheter represented by the term less invasive
surfactant administration (LISA) for respiratory distress syndrome in spontaneously breathing
preterm infants was developed as an alternative to endotracheal intubation.
Methods: We conducted a meta-analysis to assess the effects of LISA when compared to the socalled
intubation-surfactant-extubation (INSURE) and the standard endotracheal intubation and mechanical
ventilation (MV). The primary outcome was the composite incidence of death or bronchopulmonary
dysplasia at a postmenstrual age of 36 weeks. The secondary outcome was the composite
incidence of seven other severe adverse events. On 06 October 2021, we searched randomized
clinical trials (RCTs) in PubMed, the Cochrane Library, ClinicalTrials.gov, and the ICTRP
Registry.
Results: We included 18 RCTs. The pooled data on the primary outcome favored LISA when compared
to either INSURE (risk ratio 0.67; 95% CI, 0.51 to 0.88) or MV (risk ratio 0.78; 95% CI, 0.61
to 0.99). The pooled data on the second outcome also favored LISA when compared to INSURE
(risk ratio 0.75; 95% CI, 0.60 to 0.94) and MV (risk ratio 0.73; 95% CI, 0.55 to 0.96).
Conclusion: The findings showed that surfactant application by non-intubation respiratory support
and the use of a thin catheter may decrease the composite risk of death or bronchopulmonary dysplasia.
The included data support the view that LISA should be considered the preferred treatment
option in eligible infants.
