title: Pharyngeal instillation of surfactant before the first breath for prevention of morbidity and mortality in preterm infants at risk of respiratory distress syndrome.
abstract: BACKGROUND
  Intrapartum pharyngeal instillation of surfactant before the first breath may result in surfactant administration to the infant lung, with the potential benefit of avoiding endotracheal intubation and ventilation, ventilator induced lung injury and bronchopulmonary dysplasia.
  
  
  OBJECTIVE
  To determine the effect of pharyngeal instillation of surfactant before the first breath compared to placebo, no treatment or intratracheal surfactant administration followed by intermittent positive pressure ventilation (IPPV) on morbidity and mortality in preterm infants at risk of respiratory distress syndrome (RDS).
  
  
  METHODS
  Searches were made of CENTRAL (The Cochrane Library, to September 2010), MEDLINE and PREMEDLINE (1950 to September 2010), EMBASE (1980 to 2010) and CINAHL (1982 to 2010). This strategy was supplemented by searches of proceedings of scientific meetings, Google Scholar and reference lists of identified studies, as well as contact with expert informants and surfactant manufacturers.
  
  
  METHODS
  Published, unpublished and ongoing randomised controlled or quasi-randomised trials (using individual or cluster allocation) of pharyngeal instillation of surfactant before the first breath compared to placebo or no treatment, or intratracheal surfactant instillation followed by IPPV, on morbidity and mortality in preterm infants at risk of RDS.
  
  
  METHODS
  Two authors independently assessed study eligibility and quality.
  
  
  RESULTS
  No published, unpublished or ongoing trials that met the inclusion criteria for this review were found.
  
  
  CONCLUSIONS
  There were no data from randomised controlled or quasi-randomised trials that evaluated the effect of intrapartum instillation of pharyngeal surfactant before the first breath. Evidence from animal and observational human studies suggest that pharyngeal instillation of surfactant before the first breath is potentially safe, feasible and may be effective. Well designed trials are needed.
authors.affiliation: Department of Neonatology, Australian National University Medical School, PO Box 11, Woden, ACT, Australia, 2606.
authors.forename: Mohamed E
authors.initials: ME
authors.lastname: Abdel-Latif
authors.forename: David A
authors.initials: DA
authors.lastname: Osborn
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007322:Instillation, Drug; D010614:Pharynx; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012119:Respiration; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control*
chemical_list: D011663:Pulmonary Surfactants