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. 2024 Jan 25;1(1):CD008309.
doi: 10.1002/14651858.CD008309.pub3.

Laryngeal mask airway surfactant administration for prevention of morbidity and mortality in preterm infants with or at risk of respiratory distress syndrome

Mohamed E Abdel-Latif  1   2   3 , Elizabeth Walker  4 , David A Osborn  5   6
Affiliations

Laryngeal mask airway surfactant administration for prevention of morbidity and mortality in preterm infants with or at risk of respiratory distress syndrome

Mohamed E Abdel-Latif et al. Cochrane Database Syst Rev. .

Abstract

Background: Laryngeal mask airway surfactant administration (S-LMA) has the potential benefit of surfactant administration whilst avoiding endotracheal intubation and ventilation, ventilator-induced lung injury and bronchopulmonary dysplasia (BPD).

Objectives: To evaluate the benefits and harms of S-LMA either as prophylaxis or treatment (rescue) compared to placebo, no treatment, or intratracheal surfactant administration via an endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) or extubate at standard criteria (S-ETT) or via other less-invasive surfactant administration (LISA) methods on morbidity and mortality in preterm infants with or at risk of respiratory distress syndrome (RDS).

Search methods: We searched CENTRAL, MEDLINE, Embase, CINAHL, and three trial registries in December 2022.

Selection criteria: Randomised controlled trials (RCTs), cluster- or quasi-RCTs of S-LMA compared to placebo, no treatment, or other routes of administration (nebulised, pharyngeal instillation of surfactant before the first breath, thin endotracheal catheter surfactant administration or intratracheal surfactant instillation) on morbidity and mortality in preterm infants at risk of RDS. We considered published, unpublished and ongoing trials.

Data collection and analysis: Two review authors independently assessed studies for inclusion and extracted data. We used GRADE to assess the certainty of the evidence.

Main results: We included eight trials (seven new to this update) recruiting 510 newborns. Five trials (333 infants) compared S-LMA with surfactant administration via ETT with InSurE. One trial (48 infants) compared S-LMA with surfactant administration via ETT with S-ETT, and two trials (129 infants) compared S-LMA with no surfactant administration. We found no studies comparing S-LMA with LISA techniques or prophylactic or early S-LMA. S-LMA versus surfactant administration via InSurE S-LMA may have little or no effect on the composite outcome of death or BPD at 36 weeks' postmenstrual age (risk ratio (RR) 1.50, 95% confidence interval (CI) 0.27 to 8.34, I 2 = not applicable (NA) as 1 study had 0 events; risk difference (RD) 0.02, 95% CI -0.07 to 0.10; I 2 = 0%; 2 studies, 110 infants; low-certainty evidence). There may be a reduction in the need for mechanical ventilation at any time (RR 0.53, 95% CI 0.36 to 0.78; I 2 = 27%; RD -0.14, 95% CI -0.22 to -0.06, I 2 = 89%; number needed to treat for an additional beneficial outcome (NNTB) 7, 95% CI 5 to 17; 5 studies, 333 infants; low-certainty evidence). However, this was limited to four studies (236 infants) using analgesia or sedation for the InSurE group. There was little or no difference for air leak during first hospitalisation (RR 1.39, 95% CI 0.65 to 2.98; I 2 = 0%; 5 studies, 333 infants (based on 3 studies as 2 studies had 0 events); low-certainty evidence); BPD among survivors to 36 weeks' PMA (RR 1.28, 95% CI 0.47 to 3.52; I 2 = 0%; 4 studies, 264 infants (based on 3 studies as 1 study had 0 events); low-certainty evidence); or death (all causes) during the first hospitalisation (RR 0.28, 95% CI 0.01 to 6.60; I 2 = NA as 2 studies had 0 events; 3 studies, 203 infants; low-certainty evidence). Neurosensory disability was not reported. Intraventricular haemorrhage ( IVH) grades III and IV were reported among the study groups (1 study, 50 infants). S-LMA versus surfactant administration via S-ETT No study reported death or BPD at 36 weeks' PMA. S-LMA may reduce the use of mechanical ventilation at any time compared with S-ETT (RR 0.47, 95% CI 0.31 to 0.71; RD -0.54, 95% CI -0.74 to -0.34; NNTB 2, 95% CI 2 to 3; 1 study, 48 infants; low-certainty evidence). We are very uncertain whether S-LMA compared with S-ETT reduces air leak during first hospitalisation (RR 2.56, 95% CI 0.11 to 59.75), IVH grade III or IV (RR 2.56, 95% CI 0.11 to 59.75) and death (all causes) during the first hospitalisation (RR 0.17, 95% CI 0.01 to 3.37) (1 study, 48 infants; very low-certainty evidence). No study reported BPD to 36 weeks' PMA or neurosensory disability. S-LMA versus no surfactant administration Rescue surfactant could be used in both groups. There may be little or no difference in death or BPD at 36 weeks (RR 1.65, 95% CI 0.85 to 3.22; I 2 = 58%; RD 0.08, 95% CI -0.03 to 0.19; I 2 = 0%; 2 studies, 129 infants; low-certainty evidence). There was probably a reduction in the need for mechanical ventilation at any time with S-LMA compared with nasal continuous positive airway pressure without surfactant (RR 0.57, 95% CI 0.38 to 0.85; I 2 = 0%; RD -0.24, 95% CI -0.40 to -0.08; I 2 = 0%; NNTB 4, 95% CI 3 to 13; 2 studies, 129 infants; moderate-certainty evidence). There was little or no difference in air leak during first hospitalisation (RR 0.65, 95% CI 0.23 to 1.88; I 2 = 0%; 2 studies, 129 infants; low-certainty evidence) or BPD to 36 weeks' PMA (RR 1.65, 95% CI 0.85 to 3.22; I 2 = 58%; 2 studies, 129 infants; low-certainty evidence). There were no events in either group for death during the first hospitalisation (1 study, 103 infants) or IVH grade III and IV (1 study, 103 infants). No study reported neurosensory disability.

Authors' conclusions: In preterm infants less than 36 weeks' PMA, rescue S-LMA may have little or no effect on the composite outcome of death or BPD at 36 weeks' PMA. However, it may reduce the need for mechanical ventilation at any time. This benefit is limited to trials reporting the use of analgesia or sedation in the InSurE and S-ETT groups. There is low- to very-low certainty evidence for no or little difference in neonatal morbidities and mortality. Long-term outcomes are largely unreported. In preterm infants less than 32 weeks' PMA or less than 1500 g, there are insufficient data to support or refute the use of S-LMA in clinical practice. Adequately powered trials are required to determine the effect of S-LMA for prevention or early treatment of RDS in extremely preterm infants. S-LMA use should be limited to clinical trials in this group of infants.

Trial registration: ClinicalTrials.gov NCT00599651.

PubMed Disclaimer

Conflict of interest statement

MEA‐L is an Associate Editor for Cochrane Neonatal. However, his participation in the editorial group has not impacted this review.

EW: none.

DO is a Senior Editor for Cochrane Neonatal. However, his participation in the editorial group has not impacted this review.

Figures

1
1
Study flow diagram. Updated search December 2022.
2
2
Studies included in the review categorised by comparison group. Abbreviations: ETT: endotracheal tube; nCPAP: nasal continuous positive airway pressure; LMA: laryngeal mask airway; S‐LMA: surfactant administration via laryngeal mask airway; S‐ETT: surfactant administration via an endotracheal tube with extubation at standard criteria; InSurE: intubate, surfactant and extubate.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 1: Composite outcome of death or bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age (PMA)
1.2
1.2. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 2: Failure to place LMA or ETT at first attempt
1.3
1.3. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 3: Bradycardia (heart rate < 100 beats per minute) during the intervention
1.4
1.4. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 4: Hypoxaemia (oxygen saturation < 80%) during the intervention
1.5
1.5. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 5: Apnoea (cessation of spontaneous breathing > 20 seconds) during the intervention
1.6
1.6. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 6: Surfactant reflux during the intervention
1.7
1.7. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 7: Postintervention intratracheal surfactant received
1.8
1.8. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 8: Number of doses of intratracheal surfactant received postintervention
1.9
1.9. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 9: Mechanical ventilation within first 72 hours
1.10
1.10. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 10: Mechanical ventilation within first 72 hours or not ventilated but reached failure criteria as defined by the study authors
1.11
1.11. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 11: Mechanical ventilation at any time
1.12
1.12. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 12: Pulmonary air leak, any (during first hospitalisation)
1.13
1.13. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 13: Duration of any respiratory support (mechanical ventilation, continuous positive airway pressure, high flow) (days; in survivors)
1.14
1.14. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 14: Postnatal systemic corticosteroid therapy for BPD prevention
1.15
1.15. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 15: BPD (clinical definition) among survivors to 36 weeks' PMA
1.16
1.16. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 16: Any intraventricular haemorrhage
1.17
1.17. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 17: Intraventricular haemorrhage grade III and IV
1.18
1.18. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 18: Cystic periventricular leukomalacia
1.19
1.19. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 19: Patent ductus arteriosus requiring medical therapy
1.20
1.20. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 20: Necrotising enterocolitis, modified Bell stage 2 or greater
1.21
1.21. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 21: Spontaneous intestinal perforation
1.22
1.22. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 22: Retinopathy of prematurity (ROP), any grade
1.23
1.23. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 23: ROP, stage 3 or greater
1.24
1.24. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 24: Duration of hospitalisation (days)
1.25
1.25. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 25: Neonatal death (all causes) during the first 28 days
1.26
1.26. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 26: Death (all causes) during the first hospitalisation
1.27
1.27. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 27: Use of home oxygen
1.28
1.28. Analysis
Comparison 1: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – overall analysis, Outcome 28: Number of hospital readmissions with respiratory illness in the first two years
2.1
2.1. Analysis
Comparison 2: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – subgroup analyses: use of sedation and analgesia premedication, Outcome 1: Composite outcome of death or bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age (PMA)
2.2
2.2. Analysis
Comparison 2: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – subgroup analyses: use of sedation and analgesia premedication, Outcome 2: Mechanical ventilation at any time
2.3
2.3. Analysis
Comparison 2: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – subgroup analyses: use of sedation and analgesia premedication, Outcome 3: Pulmonary air leak, any (during first hospitalisation)
2.4
2.4. Analysis
Comparison 2: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – subgroup analyses: use of sedation and analgesia premedication, Outcome 4: BPD (clinical definition) among survivors to 36 weeks' PMA
2.5
2.5. Analysis
Comparison 2: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – subgroup analyses: use of sedation and analgesia premedication, Outcome 5: Intraventricular haemorrhage grade III and IV
2.6
2.6. Analysis
Comparison 2: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – subgroup analyses: use of sedation and analgesia premedication, Outcome 6: Death (all causes) during the first hospitalisation
3.1
3.1. Analysis
Comparison 3: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – subgroup analyses: gestational age, Outcome 1: Composite outcome of death or bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age (PMA)
3.2
3.2. Analysis
Comparison 3: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – subgroup analyses: gestational age, Outcome 2: Mechanical ventilation at any time
3.3
3.3. Analysis
Comparison 3: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – subgroup analyses: gestational age, Outcome 3: Pulmonary air leak, any (during first hospitalisation)
3.4
3.4. Analysis
Comparison 3: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – subgroup analyses: gestational age, Outcome 4: BPD (clinical definition) among survivors to 36 weeks' PMA
3.5
3.5. Analysis
Comparison 3: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – subgroup analyses: gestational age, Outcome 5: Intraventricular haemorrhage grade III and IV
3.6
3.6. Analysis
Comparison 3: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – subgroup analyses: gestational age, Outcome 6: Death (all causes) during the first hospitalisation
4.1
4.1. Analysis
Comparison 4: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – sensitivity analysis, Outcome 1: Failure to place LMA or ETT at first attempt
4.2
4.2. Analysis
Comparison 4: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – sensitivity analysis, Outcome 2: Surfactant reflux during the intervention
4.3
4.3. Analysis
Comparison 4: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – sensitivity analysis, Outcome 3: Postintervention intratracheal surfactant received
4.4
4.4. Analysis
Comparison 4: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – sensitivity analysis, Outcome 4: Mechanical ventilation at any time
4.5
4.5. Analysis
Comparison 4: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – sensitivity analysis, Outcome 5: Pulmonary air leak, any (during first hospitalisation)
4.6
4.6. Analysis
Comparison 4: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – sensitivity analysis, Outcome 6: Duration of any respiratory support (mechanical ventilation, continuous positive airway pressure, high flow) (days; in survivors)
4.7
4.7. Analysis
Comparison 4: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – sensitivity analysis, Outcome 7: Duration of hospitalisation (days)
4.8
4.8. Analysis
Comparison 4: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) – sensitivity analysis, Outcome 8: Number of hospital readmissions with respiratory illness in the first two years
5.1
5.1. Analysis
Comparison 5: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with extubation at standard criteria (S‐ETT) – overall analysis, Outcome 1: Postintervention intratracheal surfactant received
5.2
5.2. Analysis
Comparison 5: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with extubation at standard criteria (S‐ETT) – overall analysis, Outcome 2: Mechanical ventilation at any time
5.3
5.3. Analysis
Comparison 5: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with extubation at standard criteria (S‐ETT) – overall analysis, Outcome 3: Pulmonary air leak, any (during first hospitalisation)
5.4
5.4. Analysis
Comparison 5: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with extubation at standard criteria (S‐ETT) – overall analysis, Outcome 4: Intraventricular haemorrhage grade III and IV
5.5
5.5. Analysis
Comparison 5: Surfactant administration via laryngeal mask airway (S‐LMA) versus surfactant administration via endotracheal tube (ETT) with extubation at standard criteria (S‐ETT) – overall analysis, Outcome 5: Death (all causes) during the first hospitalisation
6.1
6.1. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 1: Composite outcome of death or bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age (PMA)
6.2
6.2. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 2: Bradycardia (heart rate < 100 beats per minute) during the intervention
6.3
6.3. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 3: Apnoea (cessation of spontaneous breathing > 20 seconds) during the intervention
6.4
6.4. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 4: Postintervention intratracheal surfactant received
6.5
6.5. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 5: Number of doses of intratracheal surfactant received postintervention
6.6
6.6. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 6: Mechanical ventilation within first 72 hours
6.7
6.7. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 7: Mechanical ventilation at any time
6.8
6.8. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 8: Pulmonary air leak, any (during first hospitalisation)
6.9
6.9. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 9: Duration of mechanical ventilation via ETT (days; in survivors)
6.10
6.10. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 10: Duration of any respiratory support (mechanical ventilation, continuous positive airway pressure, high flow) (days; in survivors)
6.11
6.11. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 11: Duration of oxygen therapy (days; in survivors)
6.12
6.12. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 12: Bronchopulmonary dysplasia (clinical definition) among survivors to 36 weeks' PMA
6.13
6.13. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 13: Any intraventricular haemorrhage
6.14
6.14. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 14: Intraventricular haemorrhage grade III and IV
6.15
6.15. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 15: Cystic periventricular leukomalacia
6.16
6.16. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 16: Neonatal death (all causes) during the first 28 days
6.17
6.17. Analysis
Comparison 6: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – overall analysis, Outcome 17: Death (all causes) during the first hospitalisation
7.1
7.1. Analysis
Comparison 7: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – subgroup analyses: gestational age, Outcome 1: Composite outcome of death or bronchopulmonary dysplasia (BPD) at 36 weeks' PMA
7.2
7.2. Analysis
Comparison 7: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – subgroup analyses: gestational age, Outcome 2: Postintervention intratracheal surfactant received
7.3
7.3. Analysis
Comparison 7: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – subgroup analyses: gestational age, Outcome 3: Mechanical ventilation at any time
7.4
7.4. Analysis
Comparison 7: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – subgroup analyses: gestational age, Outcome 4: Pulmonary air leak, any (during first hospitalisation)
7.5
7.5. Analysis
Comparison 7: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – subgroup analyses: gestational age, Outcome 5: Duration of mechanical ventilation via ETT (days; in survivors)
7.6
7.6. Analysis
Comparison 7: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – subgroup analyses: gestational age, Outcome 6: Duration of any respiratory support (mechanical ventilation, continuous positive airway pressure, high flow) (days; in survivors)
7.7
7.7. Analysis
Comparison 7: Surfactant administration via laryngeal mask airway (S‐LMA) versus no surfactant administration – subgroup analyses: gestational age, Outcome 7: BPD (clinical definition) among survivors to 36 weeks' PMA
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Update of

References

References to studies included in this review

Amini 2019 {published data only}
    1. Amini E , Sheikh M , Shariat M , Dalili H , Azadi N , Nourollahi S . Surfactant administration in preterm neonates using laryngeal mask airway: a randomized clinical trial . Acta Medica Iranica 2019. ; 57 ( 6 ): 348-54 . [pISSN: 0044-6025]
    1. IRCT201602019568N14. Surfactant administration via laryngeal mask airway (LMA) versus endotracheal tube in neonatal respiratory distress syndrome, a randomized controlled trial . trialsearch.who.int/Trial2.aspx?TrialID=IRCT201602019568N14 (first received 10 March 2016) . [CENTRAL: CN-01882974 ]
Attridge 2013 {published data only}
    1. Attridge JT , Stewart C , Stukenborg GJ , Kattwinkel J . Administration of rescue surfactant by laryngeal mask airway: lessons from a pilot trial . American Journal of Perinatology Reports 2013. ; 30 ( 3 ): 201-6 . [DOI: 10.1055/s-0032-1323592 ] [PMID: ] - DOI - PubMed
    1. NCT00599651. Randomized controlled trial of surfactant administration by laryngeal mask airway (LMA) . clinicaltrials.gov/ct2/show/NCT00599651 (first received 24 January 2008) . [CENTRAL: CN-01516614 ]
    1. Stewart C , Attridge J , Kattwinkel J . Randomised controlled trial of surfactant administration by laryngeal mask airway (LMA) . In: American Pediatric Society / Society for Pediatric Research Abstract . 2008. .
Barbosa 2017 {published data only}
    1. Barbosa RF , Simoes ES , Silva YP . A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates . Jornal de Pediatria 2017. ; 93 ( 4 ): 343-50 . [DOI: 10.1016/j.jped.2016.08.007 ] [PMID: ] - DOI - PubMed
    1. NCT01173237. Efficacy evaluation of surfactant administration for respiratory distress syndrome treatment via laryngeal mask airway. A randomized controlled trial . clinicaltrials.gov/ct2/show/NCT01173237 (first received 2 August 2010) . [CENTRAL: CN-01530800 ]
Gallup 2022 {published data only}
    1. Gallup JA , Ndakor SM , Pezzano C , Pinheiro JM . Randomized trial of surfactant therapy via laryngeal mask airway versus brief tracheal intubation in preterm neonates . Journal of Pediatrics 2022. ; S0022-3476 ( 22 ): 00891-5 . [DOI: 10.1016/j.jpeds.2022.10.009 ] [PMID: ] - DOI - PubMed
    1. Gallup JA , Pinheiro JM , Ndakor SM , Pezzano C . Randomized trial of surfactant therapy via laryngeal mask airway vs brief tracheal intubation . Pediatrics 2021. ; 147 ( 3 ): 755-6 . [DOI: 10.1542/peds.147.3MA8.755 ] - DOI - PubMed
    1. NCT02164734. Efficacy of rescue surfactant delivery via endotracheal intubation (InSurE technique) versus laryngeal mask airway (LMA) for respiratory distress syndrome (RDS) in preterm neonates [Surfactant via endotracheal tube vs. laryngeal mask airway (LMA) in preterm neonates with respiratory distress syndrome]. clinicaltrials.gov/ct2/show/NCT02164734 (first received 17 June 2014) . [CENTRAL: CN-01546455 ]
Gharehbaghi 2018 {published data only}
    1. Gharehbaghi M , Moghaddam YJ , Radfar R . Comparing the efficacy of surfactant administration by laryngeal mask airway and endotracheal intubation in neonatal respiratory distress syndrome . Crescent Journal of Medical and Biological Sciences 2018. ; 5 ( 3 ): 222-7 . [ISSN: 2148-9696]
    1. IRCT201411183915N12. Comparing the efficacy of surfactant administration by laryngeal mask airway (LMA) and endotracheal intubation in neonatal respiratory distress syndrome . trialsearch.who.int/Trial2.aspx?TrialID=IRCT201411183915N12 (first received 28 November 2014) . [CENTRAL: CN-01855189 ]
Pinheiro 2016 {published data only}
    1. NCT01042600. Rescue surfactant for respiratory distress syndrome (RDS) in newborns: comparing efficacy of delivery via laryngeal mask airway to delivery by endotracheal intubation [Randomized controlled trial of surfactant delivery via laryngeal mask airway (LMA) versus endotracheal Intubation]. clinicaltrials.gov/ct2/show/NCT01042600 (first received 5 January 2010) . [CENTRAL: CN-01527465 ]
    1. Pinheiro JM , Santana-Rivas Q , Pezzano C . Randomized trial of laryngeal mask airway versus endotracheal intubation for surfactant delivery . Journal of Perinatology 2016. ; 36 ( 3 ): 196-201 . [DOI: 10.1038/jp.2015.177 ] [PMID: ] - DOI - PubMed
    1. Santana-Rivas Q , Pinheiro J , Pezzano C . Trial of surfactant administration via laryngeal mask airway (LMA) vs. endotracheal intubation with premedication in neonatal respiratory distress syndrome (RDS) . In: Pediatric Academic Societies Annual Meeting . 2013. .
Roberts 2018 {published data only}
    1. Groberg A , Dintaman J . Can laryngeal mask airway be used for surfactant administration in neonates? Journal of Perinatology 2019. ; 39 ( 1 ): 8-10 . [DOI: 10.1038/s41372-018-0238-0 ] [PMID: ] - DOI - PubMed
    1. NCT01116921. Laryngeal mask airway (LMA) for surfactant administration in neonates . clinicaltrials.gov/ct2/show/NCT01116921 (first received 5 May 2010) . [CENTRAL: CN-01576428 ]
    1. Roberts K , Lampland A , Leone T , Tipnis J , Stepka E , Kessel J , et al. Laryngeal mask airway for surfactant administration in neonates . European Journal of Pediatrics 2016. ; 175 ( 11 ): 1491 . - PubMed
    1. Roberts KD , Brown R , Lampland AL , Leone TA , Rudser KD , Finer NN , et al. Laryngeal mask airway for surfactant administration in neonates: a randomized, controlled trial . Journal of Pediatrics 2018. ; 193 : 40-6.e1 . [DOI: 10.1016/j.jpeds.2017.09.068 ] [PMID: ] - DOI - PubMed
    1. Roberts KD , Finer N , Lampland A , Leone T , Tipnis J , Merritt T , et al. Laryngeal mask airway for surfactant administration in neonates . Journal of Investigative Medicine 2016. ; 64 ( 1 ): 157 .
Sadeghnia 2014 {published data only}
    1. Sadeghnia A , Tanhaei M , Mohammadizadeh M , Nemati M . A comparison of surfactant administration through i-Gel and ET-tube in the treatment of respiratory distress syndrome in newborns weighing more than 2000 grams . Advanced Biomedical Research 2014. ; 3 : 160 . [DOI: 10.4103/2277-9175.137875 ] [PMID: ] - DOI - PMC - PubMed

References to studies excluded from this review

Abu Leyah 2022 {published data only}
    1. Abu Leyah NA , Hasan AA , Juneau JN , Al Jammal MA , Jaber GA , Wilding GE , et al. Implementation of surfactant administration through laryngeal or supraglottic airways (SALSA): a Jordanian NICU's journey to improve surfactant administration . Children 2022. ; 9 ( 8 ): 1147 . [DOI: 10.3390/children9081147 ] [PMID: ] - DOI - PMC - PubMed
Barbosa 2012 {published data only}
    1. Barbosa RF , Marcatto Jde O , Silva AC , Silva YP . ProSealTM laryngeal mask airway for surfactant administration in the treatment of respiratory distress syndrome in a premature infant . Revista Brasileira de Terapia Intensiva 2012. ; 24 ( 2 ): 207-10 . [PMID: ] - PubMed
Brimacombe 2004 {published data only}
    1. Brimacombe J , Gandini D , Keller C . The laryngeal mask airway for administration of surfactant in two neonates with respiratory distress syndrome . Paediatric Anaesthesia 2004. ; 14 ( 2 ): 188-90 . [PMID: ] - PubMed
Guthrie 2021 {published data only}
    1. Guthrie SO , Fort P , Roberts KD . Surfactant administration through laryngeal or supraglottic airways . NeoReviews 2021. ; 22 ( 10 ): e673-88 . [DOI: 10.1542/neo.22-10-e673 ] [PMID: ] - DOI - PubMed
Kaushal 2020 {published data only}
    1. Kaushal M , Asghar S , Kaushal A , Augustine P , Alex M . Surfactant administration through laryngeal supraglottic airway (SALSA): a unique and new technique of surfactant administration . Edorium Journal of Maternal and Child Health 2020. ; 5 : 100008M01MK2020 . [DOI: 10.5348/100008M01MK2020TR ] - DOI
Micaglio 2008 {published data only}
    1. Micaglio M , Zanardo V , Ori C , Parotto M , Doglioni N , Trevisanuto D . ProSeal LMA for surfactant administration . Paediatric Anaesthesia 2008. ; 18 ( 1 ): 91-2 . [DOI: 10.1111/j.1460-9592.2007.02371.x ] [PMID: ] - DOI - PubMed
Roberts 2010 {published data only}
    1. Roberts KD , Lampland AL , Meyers PA , Worwa CT , Plumm BJ , Mammel MC . Laryngeal mask airway for surfactant administration in a newborn animal model . Pediatric Research 2010. ; 68 ( 5 ): 414-8 . [DOI: 10.1203/PDR.0b013e3181ef7619 ] [PMID: ] - DOI - PubMed
Smee 2022 {published data only}
    1. Smee N , Boyd D , Conetta H , O'Shea J . Surfactant administration by laryngeal mask to treat neonates with respiratory distress syndrome: a report following treating 60 infants in two neonatal units . Scottish Medical Journal 2022. ; 67 ( 1 ): 60 .
Trevisanuto 2005 {published data only}
    1. Trevisanuto D , Grazzina N , Ferrarese P , Micaglio M , Verghese C , Zanardo V . Laryngeal mask airway as a delivery channel for administration of surfactant in preterm infants with RDS . Biology of the Neonate 2005. ; 87 ( 4 ): 217-20 . [DOI: 10.1159/000083370 ] [PMID: ] - DOI - PubMed
    1. Trevisanuto D , Grazzina N , Micaglio M , Ferrarese P , Zanardo V . Laryngeal mask airway as a delivery channel for administration of surfactant in preterm infants with RDS [Abstract 2920] . In: Proceedings of the American Pediatric Society / Society for Pediatric Research . 2004. .
Vannozzi 2017 {published data only}
    1. Vannozzi I , Ciantelli M , Moscuzza F , Scaramuzzo RT , Panizza D , Sigali E , et al. Catheter and laryngeal mask endotracheal surfactant therapy: the CALMEST approach as a novel MIST technique . Journal of Maternal-Fetal and Neonatal Medicine 2017. ; 30 ( 19 ): 2375-7 . [DOI: 10.1080/14767058.2016.1248938 ] [PMID: ] - DOI - PubMed
Zapata 2022 {published data only}
    1. Zapata HA , Fort P , Roberts KD , Kaluarachchi DC , Guthrie SO . Surfactant administration through laryngeal or supraglottic airways (SALSA): a viable method for low-income and middle-income countries . Frontiers in Pediatrics 2022. ; 10 : 853831 . [DOI: 10.3389/fped.2022.853831 ] [PMID: ] - DOI - PMC - PubMed
Zhong 2020 {published data only}
    1. Zhong XM . Effects of LISA combined with positive laryngeal mask airway pressure into alveolar surfactant on PO2 and PCO2 in neonates with NRDS [LISA技术联合喉罩气道正压通气滴入肺泡表面活性物质对NRDS患儿PO2、PCO2的影响]. Journal of Gannan Medical College 2020. ; 12 : 1209-12 .

References to ongoing studies

ANZCTRN12619000995178 {published data only}
    1. ACTRN12619000995178. Surfactant administration by either supraglottic airway device (SAD) or direct laryngoscopy in late preterm and term newborns on nasal continuous positive airway pressure (nCPAP): a randomised, multi-centre, non-inferiority trial [The SAINT trial: Surfactant by supraglottic Airway versus direct laryngoscopy IN late preterm and Term newborns]. trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12619000995178 (first received 12 July 2019) . [CENTRAL: CN-01974801 ]
CTRI/2016/12/007540 {published data only}
    1. CTRI/2016/12/007540. Laryngeal mask airway versus endotracheal tube for surfactant administration in respiratory distress syndrome in preterm neonates more than 30 weeks of gestation – a randomized control trial [A clinical trial to study the effects of two methods of surfactant administration, through laryngeal mask airway and endotracheal tube in preterm babies with respiratory distress syndrome]. trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2016/12/007540 (first received 6 December 2016) . [CENTRAL: CN-01807424 ]

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References to other published versions of this review

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