Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Greece, Greece.
Department of Biomedical Science and Human Oncology, Neonatology and Neonatal Intensive Care Section, Policlinico Hospital, University of Bari Aldo Moro, Bari, Italy.
Arch Dis Child Fetal Neonatal Ed. 2021 Sep;106(5):474-487. doi: 10.1136/archdischild-2020-319763. Epub 2021 Jan 15.
To compare surfactant administration via thin catheters, laryngeal mask, nebulisation, pharyngeal instillation, intubation and surfactant administration followed by immediate extubation (InSurE) and no surfactant administration.
Network meta-analysis.
Medline, Scopus, CENTRAL, Web of Science, Google-scholar and Clinicaltrials.gov databases were systematically searched from inception to 15 February 2020.
Preterm neonates with respiratory distress syndrome.
Less invasive surfactant administration.
The primary outcomes were mortality, mechanical ventilation and bronchopulmonary dysplasia.
Overall, 16 randomised controlled trials (RCTs) and 20 observational studies were included (N=13 234). For the InSurE group, the median risk of mortality, mechanical ventilation and bronchopulmonary dysplasia were 7.8%, 42.1% and 10%, respectively. Compared with InSurE, administration via thin catheter was associated with significantly lower rates of mortality (OR: 0.64, 95% CI: 0.54 to 0.76), mechanical ventilation (OR: 0.43, 95% CI: 0.29 to 0.63), bronchopulmonary dysplasia (OR: 0.57, 95% CI: 0.44 to 0.73), periventricular leukomalacia (OR: 0.66, 95% CI: 0.53 to 0.82) with moderate quality of evidence and necrotising enterocolitis (OR: 0.67, 95% CI: 0.41 to 0.9, low quality of evidence). No significant differences were observed by comparing InSurE with administration via laryngeal mask, nebulisation or pharyngeal instillation. In RCTs, thin catheter administration lowered the rates of mechanical ventilation (OR: 0.39, 95% CI: 0.26 to 0.60) but not the incidence of the remaining outcomes.
Among preterm infants, surfactant administration via thin catheters was associated with lower likelihood of mortality, need for mechanical ventilation and bronchopulmonary dysplasia compared with InSurE. Further research is needed to reach firm conclusions about the efficacy of alternative minimally invasive techniques of surfactant administration.
比较经细导管、喉罩、雾化、咽灌、插管及表面活性剂给药后即刻拔管（InSurE）和未给予表面活性剂治疗的表面活性剂给药方法。
网络荟萃分析。
系统检索了 Medline、Scopus、CENTRAL、Web of Science、Google Scholar 和 Clinicaltrials.gov 数据库，检索时间从建库至 2020 年 2 月 15 日。
患有呼吸窘迫综合征的早产儿。
微创表面活性剂给药。
主要结局为死亡率、机械通气和支气管肺发育不良。
共纳入 16 项随机对照试验（RCT）和 20 项观察性研究（N=13234）。对于 InSurE 组，死亡率、机械通气和支气管肺发育不良的中位风险分别为 7.8%、42.1%和 10%。与 InSurE 相比，经细导管给药的死亡率（OR：0.64，95%CI：0.54 至 0.76）、机械通气（OR：0.43，95%CI：0.29 至 0.63）、支气管肺发育不良（OR：0.57，95%CI：0.44 至 0.73）、脑室周围白质软化（OR：0.66，95%CI：0.53 至 0.82）的发生率显著降低，证据质量为中等，坏死性小肠结肠炎（OR：0.67，95%CI：0.41 至 0.9，证据质量低）。与喉罩、雾化或咽灌相比，InSurE 与经细导管、喉罩、雾化或咽灌之间未见差异。在 RCT 中，细导管给药降低了机械通气的发生率（OR：0.39，95%CI：0.26 至 0.60），但并未降低其余结局的发生率。
与 InSurE 相比，经细导管给予表面活性剂治疗早产儿，其死亡率、机械通气需求和支气管肺发育不良的可能性更低。需要进一步的研究来确定替代的微创表面活性剂给药技术的疗效。
