Less invasive surfactant administration versus intubation-surfactant-extubation in the treatment of neonatal respiratory distress syndrome: a systematic review and meta-analyses

Silveira, Rita C.; Panceri, Carolina; Munõz, Nathália Peter; Carvalho, Mirian Basílio; Fraga, Aline Costa; Procianoy, Renato Soibelmann

doi:10.1016/j.jped.2023.05.008

Jornal de Pediatria

2024

DOI: 10.1016/j.jped.2023.05.008

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Less invasive surfactant administration versus intubation-surfactant-extubation in the treatment of neonatal respiratory distress syndrome: a systematic review and meta-analyses

Rita C. Silveira,

Carolina Panceri,

Nathália Peter Munõz

et al.

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2024

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Cited by 6 publications

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Antibiotics and beyond: Unraveling the dynamics of bronchopulmonary dysplasia in very preterm infants

Menegolla,

Silveira,

Görgen

et al. 2024

Pediatric Pulmonology

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BackgroundBronchopulmonary dysplasia (BPD) remains a significant challenge in neonatal care. Prenatal inflammation and neonatal sepsis contribute to the multifactorial nature of BPD. A potential association between empirical antibiotic therapy and BPD risk has been proposed due to microbiota dysbiosis in very low birth weight premature infants.MethodsA single centered retrospective cohort study of preterm infants (24–32 weeks gestation) from 2014 to 2021. The study compared groups that received empirical antibiotics in the first days of life and those that did not receive any antibiotic in the first days of life. The primary outcomes studied were BPD, death, and the combined outcome of BPD/death. Statistical analysis employed t‐tests, Mann‐Whitney U, Chi‐square, and logistic regression.ResultsOf 454 preterm infants, 61.5% received antibiotics. This group had lower gestational age, birth weight, and Apgar scores. Antibiotic use was associated with higher incidence of BPD (35.5% vs. 10.3%), death (21.5% vs. 8.6%), and combined outcomes (54.5% vs. 18.3%). In multivariate analysis, antibiotic use independently associated with BPD (OR 2.58, p < 0.001) and combined outcome BPD/death (OR 2.06, p < 0.02). Antenatal corticosteroids provided protection against BPD, but not mortality.ConclusionThis study suggests an association between early empirical antibiotic use and BPD in preterm infants, emphasizing the need for judicious antibiotic practices in neonatal care.

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Antibiotics and beyond: Unraveling the dynamics of bronchopulmonary dysplasia in very preterm infants

Menegolla,

Silveira,

Görgen

et al. 2024

Pediatric Pulmonology

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MIST or INSURE in Preterm Infants with Respiratory Distress Syndrome

Sayed,

Hassanien,

Khalaf

et al. 2024

Journal of Child Science

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Premature infants with respiratory distress syndrome (RDS) are typically administered surfactant via the intubation and extubation procedure (INSURE). A variety of surfactant administration practices are available today. The term “SURE” (surfactant without endotracheal intubation) refers to any approach that requires direct laryngoscopy but uses a narrow catheter instead of an endotracheal tube. They include Take Care, LISA (least invasive surfactant administration), and MIST (minimally invasive surfactant therapy). MIST approaches avoid intubation while minimizing airway damage and barotrauma. This study sought to determine the practicality, effectiveness, and security of using the MIST approach to administer surfactant to premature infants with RDS. The study examined 90 preterm infants who were born before 36 weeks with respiratory distress and were able to breathe on their own. They were divided into two groups of 45 infants each: the MIST and INSURE groups. Both surfactant administration procedures were tested to determine their impact on morbidity and mortality in newborns. The study revealed no noticeable differences between both groups in maternal or newborn factors. Still, the MIST group exhibited a significantly decreasing necessity of mechanical ventilation (MV), had shorter MV and continuous positive airway pressure durations, and significantly reduced periventricular–intraventricular hemorrhage (PIVH) and death. The MIST procedure is pragmatic and reliable, and it decreases the need for MV and mortality in preterm infants who need surfactant treatment. It decreases the occurrence of PIVH in susceptible subgroups.

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Less Invasive Surfactant Administration Compared to Intubation, Surfactant, Rapid Extubation Method in Preterm Neonates: An Umbrella Review

Kuitunen,

Räsänen

2024

Neonatology

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Introduction: In spontaneously breathing neonates, surfactant can be administered via thin catheter while enabling the own breathing (less invasive surfactant administration [LISA]). Alternatively, the neonate is intubated for surfactant delivery (intubation, surfactant, rapid extubation [INSURE]). Thus, the aim was to provide an overview of the efficacy of the LISA compared to INSURE. Methods: We performed an umbrella review of previous meta-analyses including randomized controlled trials. We searched PubMed, Scopus, and Web of Science in July 2023. Two authors screened the search results, and systematic reviews with meta-analyses that focused on LISA versus INSURE were included. One author extracted, and another author validated the extracted data. AMSTAR-2 and ROBIS evaluations were performed by two authors independently. Results: A total of 9 systematic reviews with meta-analyses were included. The quality according to AMSTAR-2 was high in one, moderate in one, low in three, and critically low in four. According to ROBIS, the risk of bias was low in three and high in six of the reviews. LISA was more effective than INSURE in preventing mechanical ventilation (8/8 reviews), death or BPD (4/4 reviews), death (3/9 reviews), and BPD (3/9 reviews). Conclusions: All the included systematic reviews and meta-analyses reported LISA to be more effective than INSURE in terms of need for mechanical ventilation and death or BPD. However, the quality of the published systematic reviews has been mostly deficient. Future systematic reviews should focus on reporting quality.

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Less invasive surfactant administration versus intubation-surfactant-extubation in the treatment of neonatal respiratory distress syndrome: a systematic review and meta-analyses

Cited by 6 publications

References 30 publications

Antibiotics and beyond: Unraveling the dynamics of bronchopulmonary dysplasia in very preterm infants

Antibiotics and beyond: Unraveling the dynamics of bronchopulmonary dysplasia in very preterm infants

MIST or INSURE in Preterm Infants with Respiratory Distress Syndrome

Less Invasive Surfactant Administration Compared to Intubation, Surfactant, Rapid Extubation Method in Preterm Neonates: An Umbrella Review

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