Less Invasive Surfactant Administration Compared to Intubation, Surfactant, Rapid Extubation Method in Preterm Neonates: An Umbrella Review

Overview

Journal Neonatology

Publisher Karger

Specialty Gynecology & Obstetrics

Date 2024 Mar 19

PMID 38503270

Authors

Ilari Kuitunen

Kati Rasanen

Affiliations

Soon will be listed here.

Abstract

Introduction: In spontaneously breathing neonates, surfactant can be administered via thin catheter while enabling the own breathing (less invasive surfactant administration [LISA]). Alternatively, the neonate is intubated for surfactant delivery (intubation, surfactant, rapid extubation [INSURE]). Thus, the aim was to provide an overview of the efficacy of the LISA compared to INSURE.

Methods: We performed an umbrella review of previous meta-analyses including randomized controlled trials. We searched PubMed, Scopus, and Web of Science in July 2023. Two authors screened the search results, and systematic reviews with meta-analyses that focused on LISA versus INSURE were included. One author extracted, and another author validated the extracted data. AMSTAR-2 and ROBIS evaluations were performed by two authors independently.

Results: A total of 9 systematic reviews with meta-analyses were included. The quality according to AMSTAR-2 was high in one, moderate in one, low in three, and critically low in four. According to ROBIS, the risk of bias was low in three and high in six of the reviews. LISA was more effective than INSURE in preventing mechanical ventilation (8/8 reviews), death or BPD (4/4 reviews), death (3/9 reviews), and BPD (3/9 reviews).

Conclusions: All the included systematic reviews and meta-analyses reported LISA to be more effective than INSURE in terms of need for mechanical ventilation and death or BPD. However, the quality of the published systematic reviews has been mostly deficient. Future systematic reviews should focus on reporting quality.

Citing Articles

Finding treasure in the journey: a single center quality improvement bundle to reduce bronchopulmonary dysplasia.

Adiletta N, Denslow A, Martinez R, Walti B, Fridolfsson P, Rockey J J Perinatol. 2024; .

PMID: 39592861 DOI: 10.1038/s41372-024-02190-0.

References

Soderstrom F, Agren J, Sindelar R . Early extubation is associated with shorter duration of mechanical ventilation and lower incidence of bronchopulmonary dysplasia. Early Hum Dev. 2021; 163:105467. DOI: 10.1016/j.earlhumdev.2021.105467. View

Herting E, Kribs A, Hartel C, Von der Wense A, Weller U, Hoehn T . Two-year outcome data suggest that less invasive surfactant administration (LISA) is safe. Results from the follow-up of the randomized controlled AMV (avoid mechanical ventilation) study. Eur J Pediatr. 2020; 179(8):1309-1313. PMC: 7351829. DOI: 10.1007/s00431-020-03572-0. View

Roberts C, Manley B, OShea J, Stark M, Andersen C, Davis P . Supraglottic airway devices for administration of surfactant to newborn infants with respiratory distress syndrome: a narrative review. Arch Dis Child Fetal Neonatal Ed. 2020; 106(3):336-341. DOI: 10.1136/archdischild-2020-319804. View

Silveira R, Panceri C, Munoz N, Carvalho M, Fraga A, Procianoy R . Less invasive surfactant administration versus intubation-surfactant-extubation in the treatment of neonatal respiratory distress syndrome: a systematic review and meta-analyses. J Pediatr (Rio J). 2023; 100(1):8-24. PMC: 10751720. DOI: 10.1016/j.jped.2023.05.008. View

Aromataris E, Fernandez R, Godfrey C, Holly C, Khalil H, Tungpunkom P . Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc. 2015; 13(3):132-40. DOI: 10.1097/XEB.0000000000000055. View

Shea B, Reeves B, Wells G, Thuku M, Hamel C, Moran J . AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017; 358:j4008. PMC: 5833365. DOI: 10.1136/bmj.j4008. View

De Luca D, Shankar-Aguilera S, Bancalari E . LISA/MIST: Complex clinical problems almost never have easy solutions. Semin Fetal Neonatal Med. 2021; 26(2):101230. DOI: 10.1016/j.siny.2021.101230. View

Dargaville P, Kamlin C, Orsini F, Wang X, De Paoli A, Kanmaz Kutman H . Two-Year Outcomes After Minimally Invasive Surfactant Therapy in Preterm Infants: Follow-Up of the OPTIMIST-A Randomized Clinical Trial. JAMA. 2023; 330(11):1054-1063. PMC: 10495923. DOI: 10.1001/jama.2023.15694. View

Lai N, Yap A, Ong H, Wai S, Yeo J, Koo C . Use of Composite Outcomes in Neonatal Trials: An Analysis of the Cochrane Reviews. Neonatology. 2021; 118(3):259-263. DOI: 10.1159/000514402. View

10.

Vento G, Ventura M, Pastorino R, van Kaam A, Carnielli V, Cools F . Lung recruitment before surfactant administration in extremely preterm neonates with respiratory distress syndrome (IN-REC-SUR-E): a randomised, unblinded, controlled trial. Lancet Respir Med. 2020; 9(2):159-166. DOI: 10.1016/S2213-2600(20)30179-X. View

11.

Janssen L, Van Der Spil J, van Kaam A, Dieleman J, Andriessen P, Onland W . Minimally invasive surfactant therapy failure: risk factors and outcome. Arch Dis Child Fetal Neonatal Ed. 2019; 104(6):F636-F642. DOI: 10.1136/archdischild-2018-316258. View

12.

Gopel W, Kribs A, Ziegler A, Laux R, Hoehn T, Wieg C . Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. Lancet. 2011; 378(9803):1627-34. DOI: 10.1016/S0140-6736(11)60986-0. View

13.

De Luca D, Shankar-Aguilera S, Centorrino R, Fortas F, Yousef N, Carnielli V . Less invasive surfactant administration: a word of caution. Lancet Child Adolesc Health. 2020; 4(4):331-340. DOI: 10.1016/S2352-4642(19)30405-5. View

14.

Devi U, Pandita A . Surfactant delivery via thin catheters: Methods, limitations, and outcomes. Pediatr Pulmonol. 2021; 56(10):3126-3141. DOI: 10.1002/ppul.25599. View

15.

Kribs A, Roll C, Gopel W, Wieg C, Groneck P, Laux R . Nonintubated Surfactant Application vs Conventional Therapy in Extremely Preterm Infants: A Randomized Clinical Trial. JAMA Pediatr. 2015; 169(8):723-30. DOI: 10.1001/jamapediatrics.2015.0504. View

16.

Sardesai S, Biniwale M, Wertheimer F, Garingo A, Ramanathan R . Evolution of surfactant therapy for respiratory distress syndrome: past, present, and future. Pediatr Res. 2016; 81(1-2):240-248. DOI: 10.1038/pr.2016.203. View

17.

Dargaville P, Kamlin C, Orsini F, Wang X, De Paoli A, Kanmaz Kutman H . Effect of Minimally Invasive Surfactant Therapy vs Sham Treatment on Death or Bronchopulmonary Dysplasia in Preterm Infants With Respiratory Distress Syndrome: The OPTIMIST-A Randomized Clinical Trial. JAMA. 2021; 326(24):2478-2487. PMC: 8715350. DOI: 10.1001/jama.2021.21892. View

18.

Abiramalatha T, Ramaswamy V, Bandyopadhyay T, Somanath S, Shaik N, Pullattayil A . Interventions to Prevent Bronchopulmonary Dysplasia in Preterm Neonates: An Umbrella Review of Systematic Reviews and Meta-analyses. JAMA Pediatr. 2022; 176(5):502-516. DOI: 10.1001/jamapediatrics.2021.6619. View

19.

Lau C, Chamberlain R, Sun S . Less Invasive Surfactant Administration Reduces the Need for Mechanical Ventilation in Preterm Infants: A Meta-Analysis. Glob Pediatr Health. 2017; 4:2333794X17696683. PMC: 5433666. DOI: 10.1177/2333794X17696683. View

20.

Herting E, Hartel C, Gopel W . Less invasive surfactant administration (LISA): chances and limitations. Arch Dis Child Fetal Neonatal Ed. 2019; 104(6):F655-F659. PMC: 6855838. DOI: 10.1136/archdischild-2018-316557. View