KEYWORDS
bronchopulmonary dysplasia; neonatal respiratory distress syndrome;
minimally invasive surfactant administration;
intubation-surfactant-extubation strategy; meta analysis1
| INTRODUCTION
Neonatal respiratory distress syndrome (NRDS), one of the most common
respiratory diseases in preterm infants, is mainly due to the lack of
pulmonary surfactant, which often results in neonatal death1. Exogenous pulmonary surfactant replacement therapy
can reduce the incidence of NRDS and neonatal mortality and
improve the long-term outcome; therefore, it is currently recognized as
the most effective treatment for NRDS 2-4. Previous
treatment options for NRDS included mechanical ventilation with
surfactant replacement therapy, except that this approach resulted in a
high incidence of ventilator-associated lung injury and bronchopulmonary
dysplasia (BPD) 5,6. Intubation, surfactant
administration, and extubation (INSURE) techniques were later developed,
which could effectively reduce the incidence of BPD and the duration of
mechanical ventilation 7,8. However, endotracheal
intubation can damage the airway 9, and transient
positive pressure ventilation can cause significant lung injury10.
In order to prevent intubation for surfactant delivery in preterm
infants with NRDS, MISA techniques are recommended, including less
invasive surfactant administration (LISA) and minimally invasive
surfactant therapy (MIST) 11.
These techniques are characterized
with the use of a thin catheter for surfactant delivery while the infant
breathes spontaneously with the support of nasal continuous positive
airway pressure (nCPAP). Nevertheless, it is still unknown whether MISA
techniques can reduce the mortality rate, as well as the incidence of
BPD and other neonatal complications compared with conventional
intubation techniques. Therefore, we systematically searched randomized
controlled trials (RCTs), compared MISA techniques with endotracheal
intubation for surfactant delivery, and conducted meta-analysis to
further clarify their efficacy and safety.
2 | METHODS
This
systematic review was conducted in accordance with the Preferred
Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)
guidelines 12.
2.1 |
Search strategy
Searches were conducted in PubMed, Embase, Cochrane Library, and Web of
Science databases from inception to November 4, 2020. Keywords and MeSH
terms were as follows: “Infant, Premature”, “Infant, Extremely
Premature”, “Premature Birth”, “MISA”, “MIST”, “LISA”, “less
invasive”, “minimally invasive”, “thin catheter”, “gastric tube”,
“nasogastric tube”, “non-intubated”, “non-intubation”,
“noninvasive”, “lung surfactant”, “pulmonary surfactant”, and
“surfactant”. We also reviewed the references in each included study
to identify any relevant papers that might have been missed from the
search.