Less Invasive Surfactant Administration Reduces the Need for Mechanical Ventilation in Preterm Infants

Abstract

Neonatal respiratory distress syndrome due to surfactant deficiency is associated with high morbidity and mortality in preterm infants, and the use of less invasive surfactant administration (LISA) has been increasingly studied. This meta-analysis found that LISA via thin catheter significantly reduced the need for mechanical ventilation within the first 72 hours (relative risk [RR] = 0.677; P = .021), duration of mechanical ventilation (difference in means [MD] = −39.302 hours; P < .001), duration of supplemental oxygen (MD = −68.874 hours; P < .001), and duration of nasal continuous positive airway pressure (nCPAP; MD = −28.423 hours; P = .010). A trend toward a reduction in the incidence of bronchopulmonary dysplasia was observed (RR = 0.656; P = .141). No significant difference in overall mortality, incidence of pneumothorax, or successful first attempts was observed. LISA via thin catheter significantly reduces the need for mechanical ventilation within the first 72 hours as well as the duration of mechanical ventilation, supplemental oxygen, and nCPAP. LISA via thin catheter appears promising in improving preterm infant outcomes.

Surfactant therapy in premature babies: SurE or InSurE

“…Kribs et al were the first to portray a strategy to administer surfactant via a thin tube using Magill forceps. Use of such a method has been shown to reduce the need for mechanical ventilation (MV) in a few of the trials . However, the evidence is not robust and the results are equivocal.…”

“…Transient bradycardia and desaturation were observed only in SurE group among 19 (11%) patients. The observed complication rate in the present study population is less than the previously reported rates . This may be explained due to higher gestation of our study population (31 vs 28 weeks) compared to the previous trial and prior training of the doctors involved in the administration of surfactant.…”

“…16 Furthermore, the SurE technique allows the infant to breathe spontaneously and thus allows rapid and complete tissue distribution present study population is less than the previously reported rates. 10,11,13 This may be explained due to higher gestation of our study population (31 vs 28 weeks) compared to the previous trial and prior training of the doctors involved in the administration of surfactant. Similarly, we can explain the low incidence of other morbidities such as IVH (2%-3%), NEC (0%-4%), and PDA (6%) in our study population compared to previous reports.…”

“…Similarly, a recent systemic review comprising of six RCT reported a lower risk of BPD (RR = 0.71 [0.52‐0.99]; NNT = 21) with least invasive surfactant technique. Similar to present study, the review did not report any difference in IVH, NEC, and PDA . Furthermore, Aldana et al in another recent meta‐analysis with a total of 895 infant observed reduction in the composite outcome of death or BPD at 36 weeks (RR = 0.75 [95% confidence interval, 0.59‐0.94); P = .01) and need for MV within 72 hours of birth (RR = 0.71 [0.53‐0.96); P = .02).…”

“…Use of such a method has been shown to reduce the need for mechanical ventilation (MV) in a few of the trials. 10…”