[Efficacy and safety of less invasive surfactant administration in the treatment of neonatal respiratory distress syndrome: a Meta analysis].

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.