A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates

Barbosa, Rosilu Ferreira; Silva, Ana Cristina Simões e; Silva, Yerkes P.

doi:10.1016/j.jped.2016.08.007

Cited by 38 publications

(38 citation statements)

References 25 publications

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“…LMA is used for both adult and children's anaesthesia and is the initial adjunctive airway device recommended by the American Society of Anaesthesiologists' di icult airway algorithm (Apfelbaum 2013). LMA use has also been tested in preterm neonates in nonresuscitation settings for surfactant administration to avoid endotracheal intubation (Barbosa 2012;Barbosa 2017;Pinheiro 2016;Wanous 2017). In a review on supraglottic airway devices during neonatal resuscitation Schmolzer 2013 included four trials that compared positive pressure ventilation delivered by an LMA versus bag and mask or an endotracheal tube.…”

Section: Description Of the Interventionmentioning

confidence: 99%

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Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation

Qureshi

Kumar

2018

Cochrane Database of Systematic Reviews

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Section: Description Of the Interventionmentioning

confidence: 99%

“…Study used LMA for surfactant administration in non-resuscitation settings Barbosa 2017 Study used LMA for surfactant administration in non-resuscitation settings.…”

Section: Participantsmentioning

confidence: 99%

Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation

Qureshi

Kumar

2018

Cochrane Database of Systematic Reviews

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“…The laryngeal mask airway, a supraglottic airway device, may be used as an interface to deliver surfactant. [42][43][44][45] However, there is currently no device available for use in very low birth weight (BW) infants, who constitute the majority of infants diagnosed with RDS.…”

Section: Introductionmentioning

confidence: 99%

Study protocol for the POPART study—Prophylactic Oropharyngeal surfactant for Preterm infants: A Randomised Trial

et al. 2020

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IntroductionMany preterm infants develop respiratory distress syndrome (RDS), a condition characterised by a relative lack of surfactant. Endotracheal surfactant therapy revolutionised the care of preterm infants in the 1990s. However, supporting newborns with RDS with continuous positive airway pressure (CPAP) and reserving endotracheal surfactant for those who develop respiratory failure despite CPAP yield better results than intubating all infants for surfactant. Half of preterm infants born before 29 weeks gestation initially managed with CPAP are intubated for surfactant. Intubation is difficult to learn and associated with adverse effects. Surfactant administration into the oropharynx has been reported in preterm animals and humans and may be effective. We wished to determine whether giving oropharyngeal surfactant at birth reduces the rate of endotracheal intubation for respiratory failure in preterm infants within 120 hours of birth.Methods and analysisProphylactic Oropharyngeal surfactant for Preterm infants: A Randomised Trial (POPART, Eudract No. 2016-004198-41) is an investigator-led, unblinded, multicentre, randomised, parallel group, controlled trial. Infants are eligible if born at a participating centre before 29 weeks gestational age (GA) and there is a plan to offer intensive care. Infants are excluded if they have major congenital anomalies. Infants are randomised at birth to treatment with oropharyngeal surfactant (120 mg vial <26 weeks GA stratum; 240 mg vial 26–28+6 weeks GA stratum) in addition to CPAP or CPAP alone. The primary outcome is intubation within 120 hours of birth, for bradycardia and/or apnoea despite respiratory support in the delivery room or respiratory failure in the intensive care unit. Secondary outcomes include incidence of mechanical ventilation, endotracheal surfactant use, chronic lung disease and death before hospital discharge.Ethics and disseminationApproval for the study has been granted by the Research Ethics Committees at the National Maternity Hospital, Dublin, Ireland (EC31.2016) and at each participating site. The trial is being conducted at nine centres in six European countries. The study results will be submitted for publication in a peer-reviewed journal.Trial registration number2016-004198-41; Pre-results.

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“…Data on the use of antenatal steroids were reported in five studies and were comparable. [11][12][13][14][15] Birth weight and gestational age were comparable between LMA and control group for each study. Mode of delivery was reported to be similar between groups in four studies.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Mode of delivery was reported to be similar between groups in four studies. [12][13][14][15] Three studies reported no significant difference in respiratory distress score between intervention groups. 13,15,16 The time for enrollment of infants reported in five studies varied between 4 and 72 hours of life.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Laryngeal Mask Airway for Surfactant Administration Versus Standard Treatment Methods in Preterm Neonates with Respiratory Distress Syndrome: A Systematic Review and Meta-analysis

et al. 2021

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Objective Laryngeal mask airway (LMA) has emerged as an alternative surfactant delivery method. The effectiveness of this method for the delivery of surfactant is uncertain. A meta-analysis of randomized control trials (RCTs) comparing LMA with standard methods of surfactant delivery for the outcomes of surfactant dose repetition, oxygen requirement, mechanical ventilation, intubation, mortality, bronchopulmonary dysplasia (BPD), and pneumothorax. Study Design Systematic review and meta-analysis of RCTs. Homogeneity between studies was analyzed by using I2 statistics. Risk ratio or mean difference of outcomes was assessed from random effects models. Subgroup analyses were conducted when necessary. Data sources are as follows: Ovid Medline, Embase, and the Cochrane Central Register of Controlled trials from inception till December 2018, bibliographies of identified reviews and trial registries for ongoing studies. RCTs comparing short-term respiratory outcomes in neonates with respiratory distress syndrome who were administered surfactant through an LMA versus standard method of care. Results Six RCTs were identified, enrolling a total of 357 infants. Administering surfactant via LMA was associated with decreased FiO2 requirement (mean difference = 1.82 (95% confidence interval [CI]: −6.01 to 9.66), decreased intubation (risk ratio [RR] = 0.17; 95% CI: 0.05–0.57), and decreased mechanical ventilation (RR = 0.44; 95% CI: 0.31–0.61). There were no significant differences between groups for death, BPD, or pneumothorax. Conclusion LMA might be an effective alternative method of surfactant delivery; however, further high-quality RCTs with larger sample size and including extreme preterm infants are needed to establish LMA as an alternative technique for surfactant delivery. Key Points

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A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates

Abstract: Surfactant administration by LMA showed short-term efficacy, with similar supplementary oxygen need compared to surfactant by ETT, and lower MV requirement. Further studies with larger sample size are necessary to confirm these results.

Cited by 38 publications

References 25 publications

Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation

Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation

Study protocol for the POPART study—Prophylactic Oropharyngeal surfactant for Preterm infants: A Randomised Trial

Laryngeal Mask Airway for Surfactant Administration Versus Standard Treatment Methods in Preterm Neonates with Respiratory Distress Syndrome: A Systematic Review and Meta-analysis

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