Overview of the Effectiveness of Different Surfactant Administration Methods: An Umbrella Review of Meta-Analyses

To compare the effectiveness of various surfactant administration methods.

We conducted an umbrella review of meta-analyses conducted on randomized controlled trials. The search was conducted in March 2024 in four databases. Two authors screened the results and extracted the data. Review quality was assessed according to AMSTAR-2. Traffic-light plots were used to summarize the effectiveness of different administration methods.

Nineteen meta-analyses comprising 247 comparisons were included. The most evaluated method was less invasive surfactant administration (LISA), across 16 comparisons versus InSurE and intubation. LISA significantly reduced risks of bronchopulmonary dysplasia (BPD), BPD or death combined, mechanical ventilation, pneumothorax/air leaks, and intraventricular hemorrhage (IVH) versus intubation; it also lowered mortality versus InSurE and intubation. No IVH difference was seen between LISA and InSurE. Five comparisons (17 outcomes) assessed laryngeal mask airway (LMA) against intubation and InSurE. LMA reduced subsequent intubation or mechanical ventilation versus intubation. Findings on post-surfactant FiO₂ were inconsistent. No differences were observed in mortality, BPD (or death), IVH, additional surfactant needs, pneumothorax, patent ductus arteriosus, desaturation, reflux, procedure failure, bradycardia, or home oxygen use between LMA and intubation, nor in BPD outcomes versus InSurE.

Based on recent meta-analyses, LISA appears to be the most effective and extensively evaluated surfactant administration method in head-to-head comparisons. Future research should clarify LMA's role and establish a definitive method hierarchy; currently, LISA remains the preferred choice when feasible.