Abstract Background: The effects of minimally invasive surfactant
administration (MISA) in preterm infants with neonatal respiratory
distress syndrome (NRDS) are unclear. Methods: We searched randomized
controlled trials (RCTs) and compared MISA techniques with intubation
for surfactant delivery in preterm infants with NRDS in PubMed, Embase,
Cochrane Library, and Web of Science. Results: Thirteen RCTs (1931
infants) were included in the meta-analysis. The use of MISA techniques
decrease the incidence of bronchopulmonary dysplasia (BPD) at 36 weeks,
pneumothorax, and hemodynamically significant patent ductus arteriosus
(hsPDA) (Risk Ratio(RR) : 0.59, 95% confidence interval (CI) : 0.46 to
0.75, p < .0001; RR : 0.60, 95% CI : 0.39 to 0.93, p= .02 and
RR : 0.88, 95% CI : 0.78 to 1.00, p= .04, respectively). In addition,
infants in the MISA group required less mechanical ventilation within 72
h of life or during hospitalization (RR : 0.60, 95% CI : 0.48 to 0.75,
p< .00001 and RR : 0.64, 95% CI : 0.49 to 0.82, p = .0005,
respectively) compared with infants in the control group. However, the
rate of surfactant reflux was higher in the MISA group than that in the
control group (RR : 2.12, 95% CI : 1.37 to 3.29, p = .0008). There were
no significant differences in mortality and other outcomes beteween the
MISA group and the control group. Conclusions: The administration of
surfactant with MISA techniques could lower the requirement for
mechanical ventilation, and decrease the incidence of BPD at 36 weeks,
pneumothorax, and hsPDA.
Minimally Invasive Surfactant Administration for the Treatment of Neonatal Respiratory Distress Syndrome: A Multicenter Randomized Study in China