title: New modalities to deliver surfactant in premature infants: a systematic review and meta-analysis.
abstract: BACKGROUND
  Surfactant is the principle treatment of respiratory distress syndrome, but the ideal method of its administration remains controversial. The intubation, surfactant administration and extubation (InSurE) method is proven to work but is invasive. The objective of this systematic review is to evaluate the efficacy and safety of the modalities of surfactant administration.
  
  
  METHODS
  We searched MEDLINE, EMBASE and CENTRAL (inception to December 2015) for randomized trials comparing new modalities with InSurE method. The primary outcome was mortality and development of bronchopulmonary dysplasia (BPD).
  
  
  RESULTS
  We screened 1837 citations and identified five unique trials were included; all were of unclear risk of bias. Four trials (400 infants) compared endotracheal catheters with InSurE, and one trial (70 infants) compared laryngeal masks (LMA) with InSurE. There was no significant difference between using endotracheal catheters compared with InSurE regarding infant mortality (risk ratio 1.05, 95% CI 0.57-1.94, 4 trials, 400 patients, p 0.87, I(2) 0%) or BPD (risk ratio 0.73, 95% CI 0.43-1.21, 4 trials, 400 patients, p 0.22, I(2) 0%). Adverse events were under-reported.
  
  
  CONCLUSIONS
  The use of endotracheal catheters may provide comparable results to the InSurE method. There is limited evidence on the comparative efficacy of LMA.
authors: a Neonatology Section, Department of Pediatrics, Winnipeg Regional Health Authority , Winnipeg , Canada .
authors: Ebtihal
authors: E
authors: Ali
authors: b Neonatology Section, Children's Hospital, Ain Shams University , Cairo , Egypt .
authors: Mohamed
authors: M
authors: Abdel Wahed
authors: c Neonatology Section, Pediatric Department, King Abdulaziz Hospital , Jeddah , KSA .
authors: Zahraa
authors: Z
authors: Alsalami
authors: d Community Health Department, Ain Shams University , Cairo , Egypt .
authors: Hasnaa
authors: H
authors: Abouseif
authors: e Neil John Maclean Health Science Library, Brodie Centre, University of Manitoba , Winnipeg , Canada .
authors: Tania
authors: T
authors: Gottschalk
authors: f George and Fay Yee Center for Healthcare Innovation, University of Manitoba , Winnipeg , Canada , and.
authors: Rasheda
authors: R
authors: Rabbani
authors: f George and Fay Yee Center for Healthcare Innovation, University of Manitoba , Winnipeg , Canada , and.|g Department of Internal Medicine , Cancer Care Manitoba , Winnipeg , Canada.
authors: Ryan
authors: R
authors: Zarychanski
authors: f George and Fay Yee Center for Healthcare Innovation, University of Manitoba , Winnipeg , Canada , and.
authors: Ahmed M
authors: AM
authors: Abou-Setta
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal / Q000379:methods*; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality / Q000628:therapy*
chemical_list: D011663:Pulmonary Surfactants
keywords: Endotracheal catheter; laryngeal mask; newborn; respiratory distress syndrome