Abstract Objective To evaluate the efficacy and safety of less invasive surfactant administration (LISA) in the treatment of neonatal respiratory distress syndrome (NRDS). Methods PubMed, Cochrane Library, Embase, China Biology Medicine disc, China Scientific Journal Database, CNKI Database, and Wanfang Database were searched for randomized controlled trials (RCTs) on the use of LISA strategy in the treatment of NRDS. Literature screening and quality assessment were performed according to inclusion and exclusion criteria. Review Manager 5.3 software was used to perform the Meta analysis. Results A total of 9 RCTs were included, with a total of 1 212 children with NRDS. There were 611 children in the experimental group (treated with LISA strategy) and 601 children in the control group[treated with intubation-surfactant-extubation (INSURE) strategy]. The Meta analysis showed that the use of LISA strategy reduced the rate of mechanical ventilation within 72 hours after birth (OR=0.39, 95% CI:0.29-0.51, P < 0.001) and the incidence rates of bronchopulmonary dysplasia (OR=0.53, 95% CI:0.38-0.72, P < 0.001) and pneumothorax (OR=0.56, 95% CI:0.33-0.93, P=0.02). There were no significant differences in the mortality rate and incidence rates of other neonatal diseases between the two groups (P > 0.05). There was no significant difference in the rate of repeated use of pulmonary surfactant (PS) between the two groups (P > 0.05), but there was a higher incidence rate of PS reflux observed by LISA strategy (OR=2.60, 95% CI:1.64-4.12, P < 0.001). Conclusions Compared with INSURE strategy, LISA strategy has advantages in reducing the need for mechanical ventilation and the incidence rates of bronchopulmonary dysplasia and pneumothorax in children with NRDS.
HUO Meng-Yue,MEI Hua,ZHANG Yu-Heng et al. Efficacy and safety of less invasive surfactant administration in the treatment of neonatal respiratory distress syndrome: a Meta analysis[J]. CJCP, 2020, 22(7): 721-727.
HUO Meng-Yue,MEI Hua,ZHANG Yu-Heng et al. Efficacy and safety of less invasive surfactant administration in the treatment of neonatal respiratory distress syndrome: a Meta analysis[J]. CJCP, 2020, 22(7): 721-727.
Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome-2019 update[J]. Neonatology, 2019, 115(4):432-450.
[2]
Chun J, Sung SI, Ho YH, et al. Prophylactic versus early rescue surfactant treatment in preterm infants born at less than 30 weeks gestation or with birth weight less than or equal 1,250 grams[J]. J Korean Med Sci, 2017, 32(8):1288-1294.
[3]
Klotz D, Porcaro U, Fleck T, et al. European perspective on less invasive surfactant administration-a survey[J]. Eur J Pediatr, 2017, 176(2):147-154.
[4]
Wyckoff MH, Aziz K, Escobedo MB, et al. Part 13:neonatal resuscitation:2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2015, 132(18 Suppl 2):S543-S560.
[5]
Kanmaz HG, Erdeve O, Canpolat FE, et al. Surfactant administration via thin catheter during spontaneous breathing:randomized controlled trial[J]. Pediatrics, 2013, 131(2):e502-e509.
[6]
Mirnia K, Heidarzadeh M, Hosseini MB, et al. Comparison outcome of surfactant administration via tracheal catheterization during spontaneous breathing with insure[J]. Med J Islamic World Acad Sci, 2013, 21(4):143-148.
[7]
Bao Y, Zhang G, Wu M, et al. A pilot study of less invasive surfactant administration in very preterm infants in a Chinese tertiary center[J]. BMC Pediatr, 2015, 15:21.
[8]
Mohammadizadeh M, Ardestani AG, Sadeghnia AR. Early administration of surfactant via a thin intratracheal catheter in preterm infants with respiratory distress syndrome:feasibility and outcome[J]. J Res Pharm Pract, 2015, 4(1):31-36.
[9]
Kribs A, Roll C, Göpel W, et al. Nonintubated surfactant application vs conventional therapy in extremely preterm infants:a randomized clinical trial[J]. JAMA Pediatr, 2015, 169(8):723-730.
[10]
Halim A, Shirazi H, Riaz S, et al. Less invasive surfactant administration in preterm infants with respiratory distress syndrome[J]. J Coll Physicians Surg Pak, 2019, 29(3):226-330.
[11]
Göpel W, Kribs A, Ziegler A, et al. Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV):an open-label, randomised, controlled trial[J]. Lancet, 2011, 378(9803):1627-1634.
Kurepa D, Perveen S, Lipener Y, et al. The use of less invasive surfactant administration (LISA) in the United States with review of the literature[J]. J Perinatol, 2019, 39(3):426-432.
[16]
Barkhuff WD, Soll RF. Novel surfactant administration techniques:will they change outcome?[J]. Neonatology, 2019, 115(4):411-422.
[17]
Kribs A. Minimally invasive surfactant therapy and noninvasive respiratory support[J]. Clin Perinatol, 2016, 43(4):755-771.
[18]
Gortner L, Schüller SS, Herting E. Review demonstrates that less invasive surfactant administration in preterm neonates leads to fewer complications[J]. Acta Paediatr, 2018, 107(5):736-743.
[19]
Härtel C, Paul P, Hanke K, et al. Less invasive surfactant administration and complications of preterm birth[J]. Sci Rep, 2018, 8(1):8333.
[20]
Langhammer K, Roth B, Kribs A, et al. Treatment and outcome data of very low birth weight infants treated with less invasive surfactant administration in comparison to intubation and mechanical ventilation in the clinical setting of a cross-sectional observational multicenter study[J]. Eur J Pediatr, 2018, 177(8):1207-1217.
[21]
Teig N, Weitkämper A, Rothermel J, et al. Observational study on less invasive surfactant administration (LISA) in preterm infants <29 weeks-short and long-term outcomes[J]. Z Geburtshilfe Neonatol, 2015, 219(6):266-273.
[22]
Kaniewska U, Gulczyńska E. The influence of the technique of surfactant administration (LISA vs INSURE) on the outcomes of respiratory distress syndrome treatment in preterm infants[J]. Dev Period Med, 2019, 23(3):163-171.
[23]
Göpel W, Kribs A, Härtel C, et al. Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants[J]. Acta Paediatr, 2015, 104(3):241-246.
[24]
Herting E, Härtel C, Göpel W. Less invasive surfactant administration (LISA):chances and limitations[J]. Arch Dis Child Fetal Neonatal Ed, 2019, 104(6):F655-F659.
