Ebtihal Ali1, Mohamed Abdel Wahed2, Zahraa Alsalami3, Hasnaa Abouseif4, Tania Gottschalk5, Rasheda Rabbani6, Ryan Zarychanski6,7, Ahmed M Abou-Setta6. 1. a Neonatology Section, Department of Pediatrics, Winnipeg Regional Health Authority , Winnipeg , Canada . 2. b Neonatology Section, Children's Hospital, Ain Shams University , Cairo , Egypt . 3. c Neonatology Section, Pediatric Department, King Abdulaziz Hospital , Jeddah , KSA . 4. d Community Health Department, Ain Shams University , Cairo , Egypt . 5. e Neil John Maclean Health Science Library, Brodie Centre, University of Manitoba , Winnipeg , Canada . 6. f George and Fay Yee Center for Healthcare Innovation, University of Manitoba , Winnipeg , Canada , and. 7. g Department of Internal Medicine , Cancer Care Manitoba , Winnipeg , Canada.
Abstract
CONTEXT: 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. CONCLUSION: The use of endotracheal catheters may provide comparable results to the InSurE method. There is limited evidence on the comparative efficacy of LMA.
CONTEXT: 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. CONCLUSION: The use of endotracheal catheters may provide comparable results to the InSurE method. There is limited evidence on the comparative efficacy of LMA.
Authors: Elizabeth Wastnedge; Donald Waters; Sarah R Murray; Brian McGowan; Effie Chipeta; Alinane Linda Nyondo-Mipando; Luis Gadama; Gladys Gadama; Martha Masamba; Monica Malata; Frank Taulo; Queen Dube; Kondwani Kawaza; Patricia Munthali Khomani; Sonia Whyte; Mia Crampin; Bridget Freyne; Jane E Norman; Rebecca M Reynolds Journal: J Glob Health Date: 2021-12-30 Impact factor: 4.413