Systematic review found that using thin catheters to deliver surfactant to preterm neonates was associated with reduced bronchopulmonary dysplasia and mechanical ventilation

Abstract

Aim: Surfactant delivery is a cornerstone for managing respiratory distress in preterm neonates, but data on the best surfactant delivery methods have been conflicting. Methods: A systematic literature review using the PubMed, Embase, Cochrane Library and Web of Science databases identified papers published up to November 5, 2019. Additional studies were identified from trial registries, conference proceedings and the reference lists of the selected papers. Results: We identified 15 studies covering 4926 preterm infants. The randomised controlled trials (RCTs) and observational studies both showed significant reductions in early intubation rates with use of thin catheters. The relative risk (RR) was 0.63 and the 95% confidence interval (95% CI) was 0.55-0.72 (P < .01), with an odds ratio (OR) of 0.40 and 95% CI of 0.35-0.45 (P < .0001). The collective results from the RCTs revealed a significant decrease in bronchopulmonary dysplasia (BPD) rates in the thin catheter group (RR, 0.47; 95% CI 0.33-0.66; P < .01). These findings were consistent with the observational studies (OR 0.47; 95% CI 0.43-0.52; P < .01). Conclusion: Using thin catheters to deliver surfactant in comparison with intubatesurfactant-extubate (INSURE) to newborn preterm infants with respiratory distress was associated with a reduced incidence of BPD and less need for mechanical ventilation.

Surfactant delivery via thin catheters: Methods, limitations, and outcomes

“…One possible explanation could be absence of hypoxia and gut ischemia associated with MV or INSURE 30 . Surprisingly, increased focal intestinal perforation with LISA was reported in a study by Hartel et al 26 However, subsequent studies and metanalysis did not report any such side effects 17,31 …”

“…Terminologies like least invasive surfactant administration (LISA), minimally invasive surfactant technique, and Take Care are used interchangeably for this technique 14–17 . Pandita et al have recently proposed a much needed classification of surfactant administration techniques to make the terminology simple and uniform across the globe.…”

“…Though different FiO 2 criteria for surfactant administration were used previously for different gestation ages, an uniform threshold of ≥0.3 has been advocated for all babies with clinical diagnosis of RDS in the recent 2019 update 49 . This FiO 2 threshold was considered for LISA within 2 h of life in some studies, 15,27,31 within 12 h 29,34,50 in few studies and within 24 h in the studies by Dargaville et al 14,20,48 Furthermore, CPAP pressures ranging from 6 to 7 cmH 2 O were used in most of these studies 17 …”

Neurodevelopmental outcomes of infants with bronchopulmonary dysplasia

“…More recent studies have investigated the impact of minimally invasive surfactant treatment (MIST) or less invasive surfactant administration (LISA), which does not require conventional endotracheal intubation. This approach also reduces BPD, though impacts on developmental outcomes are unknown 42 …”

Less-Invasive Surfactant Administration for Neonatal Respiratory Distress Syndrome: A Consensus Guideline

“…Smaller subsequent studies have also shown improved outcomes [13,14]. A recent systematic review of randomized controlled trials (RCTs) identified that LISA resulted in significantly reduced early intubation rates and BPD compared with INSURE [15]. A recent 2-year follow-up demonstrated that premature infants treated with LISA demonstrated no significant differences in weight, length, or neurodevelopmental outcome compared with infants who received standard treatment [16].…”