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Meta-Analysis
. 2024 Jan-Feb;100(1):8-24.
doi: 10.1016/j.jped.2023.05.008. Epub 2023 Jun 21.

Less invasive surfactant administration versus intubation-surfactant-extubation in the treatment of neonatal respiratory distress syndrome: a systematic review and meta-analyses

Rita C Silveira  1 , Carolina Panceri  2 , Nathália Peter Munõz  3 , Mirian Basílio Carvalho  4 , Aline Costa Fraga  3 , Renato Soibelmann Procianoy  5
Affiliations
Meta-Analysis

Less invasive surfactant administration versus intubation-surfactant-extubation in the treatment of neonatal respiratory distress syndrome: a systematic review and meta-analyses

Rita C Silveira et al. J Pediatr (Rio J). 2024 Jan-Feb.

Abstract

Objectives: To compare LISA with INSURE technique for surfactant administration in preterm with gestational age (GA) < 36 weeks with RDS in respect to the incidence of pneumothorax, bronchopulmonary dysplasia (BPD), need for mechanical ventilation (MV), regional cerebral oxygen saturation (rSO2), peri‑intraventricular hemorrhage (PIVH) and mortality.

Methods: A systematic search in PubMed, Embase, Lilacs, CINAHL, SciELO databases, Brazilian Registry of Randomized Clinical Trials (ReBEC), Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL) was performed. RCTs evaluating the effects of the LISA technique versus INSURE in preterm infants with gestational age < 36 weeks and that had as outcomes evaluation of the rates of pneumothorax, BPD, need for MV, rSO2, PIVH, and mortality were included in the meta-analysis. Random effects and hazard ratio models were used to combine all study results. Inter-study heterogeneity was assessed using Cochrane Q statistics and Higgin's I2 statistics.

Results: Sixteen RCTs published between 2012 and 2020 met the inclusion criteria, a total of 1,944 preterms. Eleven studies showed a shorter duration of MV and CPAP in the LISA group than in INSURE group. Two studies evaluated rSO2 and suggested that LISA and INSURE transiently affect brain autoregulation during surfactant administration. INSURE group had a higher risk for MV in the first 72 h of life, pneumothorax, PIVH and mortality in comparison to the LISA group.

Conclusion: This systematic review and meta-analyses provided evidence for the benefits of the LISA technique in the treatment of RDS, decreasing CPAP time, need for MV, BPD, pneumothorax, PIVH, and mortality when compared to INSURE.

Keywords: Bronchopulmonary dysplasia; INSURE; LISA; Meta-analyses; Preterm; Surfactant.

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Conflict of interest statement

Conflicts of interest The authors declare no conflicts of interest.

Figures

Fig 1
Figure 1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Fig 2
Figure 2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Fig 3
Figure 3
Flowchart of studies included in the systematic review. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/.
Fig 4
Figure 4
Forest plot of comparison: LISA AND INSURE - overall analysis of 14 studies, outcome: Mechanical Ventilation.
Fig 5
Figure 5
Forest plot of comparison: LISA AND INSURE - overall analysis of 13 studies, outcome: Bronchopulmonary dysplasia.
Fig 6
Figure 6
Forest plot of comparison: LISA AND INSURE - overall analysis of 9 studies, outcome: Pneumothorax.
Fig 7
Figure 7
Forest plot of comparison: LISA AND INSURE - overall analysis of 9 studies, outcome: MORTALITY.
Fig 8
Figure 8
Forest plot of comparison: LISA AND INSURE - overall analysis of 9 studies, outcome: PIVH.
See this image and copyright information in PMC

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