Comparative efficacy of methods for surfactant administration: a network meta-analysis

Area of Science:

• Neonatal Medicine
• Pulmonology
• Critical Care

Background:

• Respiratory distress syndrome (RDS) is a common condition in preterm neonates.
• Surfactant replacement therapy is a cornerstone of RDS management.
• Various methods exist for surfactant administration, with ongoing research into less invasive techniques.

Purpose of the Study:

• To compare the efficacy of different surfactant administration methods in preterm neonates with RDS.
• To evaluate outcomes including mortality, mechanical ventilation, and bronchopulmonary dysplasia.
• To assess less invasive surfactant administration (LISA) techniques against standard methods.

Main Methods:

• A systematic search of multiple databases (Medline, Scopus, CENTRAL, Web of Science, Google Scholar, ClinicalTrials.gov) was conducted.
• A network meta-analysis included 16 randomized controlled trials and 20 observational studies (N=13,234).
• Primary outcomes were mortality, mechanical ventilation, and bronchopulmonary dysplasia.

Main Results:

• Surfactant administration via thin catheters was associated with significantly lower rates of mortality, mechanical ventilation, and bronchopulmonary dysplasia compared to intubation and surfactant administration followed by immediate extubation (InSurE).
• Thin catheter use also showed reduced rates of periventricular leukomalacia and necrotising enterocolitis.
• No significant differences were found when comparing InSurE with laryngeal mask, nebulisation, or pharyngeal instillation methods.

Conclusions:

• Thin catheter surfactant administration is associated with improved outcomes in preterm infants with RDS.
• This method demonstrates a lower likelihood of mortality, mechanical ventilation, and bronchopulmonary dysplasia compared to InSurE.
• Further research is warranted to establish firm conclusions on the efficacy of other minimally invasive surfactant administration techniques.