Surfactant delivery via thin catheter in preterm infants: A systematic review and meta-analysis

Abstract

Objective Surfactant administration via a thin catheter (STC) is an alternative to surfactant administration post endotracheal intubation in preterm infants with respiratory distress syndrome (RDS); however, the benefits particularly in infants <29 weeks’ gestation and the neurodevelopmental outcomes remain unclear. Thus, our objective was to systematically review and meta-analyze the efficacy and safety of STC compared to intubation for surfactant or nasal continuous positive airway pressure (nCPAP) in preterm infants with RDS. Methods Medical databases were searched until December 2022 for randomized controlled trials (RCTs) assessing STC compared to controls that included intubation for surfactant or nCPAP in preterm infants with RDS. The primary outcome was bronchopulmonary dysplasia (BPD) at 36 weeks gestation in survivors. Subgroup analysis was conducted comparing STC to controls in infants < 29 weeks’ gestation. The Cochrane risk of bias (ROB) tool was used and certainty of evidence (CoE) was rated according to GRADE. Results Twenty-six RCTs of 3349 preterm infants, in which half of the studies had low risk of bias, were included. STC decreased the risk of BPD in survivors compared to controls (17 RCTs; N = 2408; relative risk (RR) = 0.66; 95% confidence interval (CI) 0.51 to 0.85; number needed to treat for an additional beneficial outcome (NNTB) = 13; CoE: moderate). In infants < 29 weeks’ gestation, STC significantly reduced the risk of BPD compared to controls (6 RCTs, N = 980; RR 0.63; 95% CI 0.47 to 0.85; NNTB = 8; CoE: moderate). Conclusions Compared to controls, STC may be a more efficacious and safe method of surfactant delivery in preterm infants with RDS, including infants < 29 weeks’ gestation.

Factores De Riesgo Para Displasia Broncopulmonar en Recién Nacido Pretérmino: ¿qué Dice La Evidencia?

“…Algunos estudios, como el de Isayama et al (21)., argumentan que LISA (administración surfactante menos invasiva) es la mejor estrategia de manejo para evitar la displasia broncopulmonar. Es importante mantener la respiración espontánea durante la administración de tensioactivos para la prevención de la displasia broncopulmonar (22,23). Los resultados del ensayo OPTIMIST-A muestran que LISA es el único enfoque entre las estrategias alternativas de administración de surfactantes con evidencia existente para prevenir la DBP, con una reducción en la incidencia de DBP en sobrevivientes a la edad postmenstrual de 36 semanas (24)(25)(26).…”

Surfactant administration during endotracheal CPAP—Is DD‐Surf comparable to LISA?

“…Improving survival of extreme preterm neonates has led to an increasing burden of Bronchopulmonary dysplasia, which is not only the most challenging respiratory morbidity faced by neonates but has significant long term respiratory and neurological adverse outcomes. Minimally invasive surfactant administration is emerging as a potential standard of care for administering surfactant in preterm neonates in view of its proven efficacy in reducing bronchopulmonary dysplasia caused due to positive pressure induced lung injury 1 . We read with great interest study done by Mense et al on their novel technique of surfactant administration 2 ; However, we have certain reservations: International European consensus guidelines recommend rescue surfactant administration once a preterm neonate needs Positive end expiratory pressure (PEEP) ≥ 6 cm of H 2 O and FiO 2 > 0.30 3 .…”