Minimally invasive surfactant administration in preterm infants: A meta-narrative review

Background: Surfactant administration by minimally invasive methods that allow for spontaneous breathing is evaluated by investigators. Methods: To perform a meta-narrative review encompassing the conceptualization, implementation, and evaluation of the efficacy and safety of minimally invasive methods of surfactant administration in preterm infants with or at risk of respiratory distress syndrome. Electronic databases, journals and conference proceedings were searched from inception until June 2013.Two reviewers independently selected studies for inclusion with third reviewer resolved the discrepancies. Two reviewers independently extracted data. Overall meta-review was conducted encompassing the evolution of non-invasive surfactant therapy and a metaanalysis was conducted using a random effects model, with risk ratio (RR) and 95% confidence interval (CI) calculated when appropriate. Results: Ten studies of 3081 neonates were included. Thin catheter administration was evaluated in six studies (two randomized, four observational), aerosolization in two randomized, and laryngeal mask and pharyngeal administration in one observational study each. The meta-review confirmed slow evolution and challenges of the different modes of administration, with thin catheter being the most studied. Meta-analysis of two studies of surfactant administration using a thin catheter revealed reduction in bronchopulmonary dysplasia (RR = 0.54, 95%CI 0.29-0.99) and decreased need for mechanical ventilation at 72 hours (RR = 0.48, 95%CI 0.36-0.65) compared with standard care. Conclusions: Surfactant administration via a thin catheter appears to be an efficacious and potentially safe method; however, further large-scale studies with long-term outcomes are needed for all methods of minimally invasive surfactant administration.