title: Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis.
abstract: BACKGROUND
  In spontaneously breathing preterm infants with respiratory distress syndrome (RDS) receiving nasal continuous positive airway pressure, a method of less invasive surfactant administration (LISA) using a thin catheter has been described as an alternative to endotracheal intubation for surfactant delivery to reduce lung injury.
  
  
  OBJECTIVE
  A systematic review of randomised controlled trials (RCTs) comparing LISA with the standard method of surfactant delivery for clinical outcomes.
  
  
  METHODS
  Medline, CENTRAL and Embase databases were searched (until 29 October 2015). Additional citations were identified from trial registries, conference proceedings and the bibliographies of selected articles. The included studies were RCTs enrolling preterm infants with RDS and compared LISA technique with intubation for surfactant delivery for any of the prespecified clinical outcomes.
  
  
  RESULTS
  Six RCTs were identified, enrolling a total of 895 infants. The use of LISA technique reduced the composite outcome of death or bronchopulmonary dysplasia (BPD) at 36 weeks (risk ratio (RR)=0.75 (95% CI 0.59 to 0.94), p=0.01), BPD36among survivors (RR=0.72 (0.53 to 0.97), p=0.03), need for mechanical ventilation within 72 hours of birth (RR=0.71 (0.53 to 0.96), p=0.02) or need for mechanical ventilation anytime during the neonatal intensive care unit stay (RR=0.66 (0.47 to 0.93), p=0.02). There were no differences noted for the outcome of death and other neonatal morbidities. Procedure failure rate on the first attempt and the need for additional doses of surfactant were not different between the intervention groups.
  
  
  CONCLUSIONS
  LISA technique for surfactant delivery results in a lesser need for mechanical ventilation in infants with RDS, reduction in the composite outcome of death or BPD at 36 weeks, and BPD36among survivors.
authors.affiliation: Neonatal Division, Department of Pediatrics, University of Alberta, Edmonton, Canada.
authors.forename: Jose C
authors.initials: JC
authors.lastname: Aldana-Aguirre
authors.affiliation: Neonatal Division, Department of Pediatrics, University of Alberta, Edmonton, Canada.
authors.forename: Merlin
authors.initials: M
authors.lastname: Pinto
authors.affiliation: Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Canada.
authors.forename: Robin M
authors.initials: RM
authors.lastname: Featherstone
authors.affiliation: Neonatal Division, Department of Pediatrics, University of Alberta, Edmonton, Canada.|Alberta Health Services, Edmonton, Canada.
authors.forename: Manoj
authors.initials: M
authors.lastname: Kumar
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods*; D004333:Drug Administration Routes; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D007442:Intubation, Intratracheal / Q000379:methods*; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*
chemical_list: D011663:Pulmonary Surfactants
keywords: InSurE; less invasive surfactant administration; meta-analysis; respiratory distress syndrome; systematic review