Abstract | IMPORTANCE:
Surfactant administration by minimally invasive methods that allow for spontaneous breathing might be safer and more effective than administration with endotracheal intubation and mechanical ventilation; however, the efficacy and safety of minimally invasive methods have not been reviewed. OBJECTIVE: To conduct a meta-narrative review of the efficacy and safety of minimally invasive surfactant administration using a thin catheter, aerosolization, a laryngeal mask airway, and pharyngeal administration in preterm infants with or at risk for respiratory distress syndrome. DATA SOURCES: We searched the PubMed, EMBASE, Cochrane, and CINAHL databases, published journals, and conference proceedings from inception to June 30, 2013. STUDY SELECTION: DATA EXTRACTION AND SYNTHESIS: An overall meta-narrative review was conducted encompassing the evolution of noninvasive surfactant therapy. Risk ratios and 95% confidence intervals are reported when appropriate. MAIN OUTCOMES AND MEASURES: RESULTS: We included 10 studies (6 randomized and 4 observational) of 3081 neonates. Thin catheter administration was evaluated in 6 studies (2 randomized and 4 observational); aerosolization, in 2 randomized studies; and laryngeal mask and pharyngeal administration, in 1 observational study each. The meta-narrative review confirmed the slow evolution and challenges of the different modes of administration, with thin catheter administration being the most studied intervention. Two randomized studies of surfactant administration using a thin catheter revealed no significant difference in the outcome of bronchopulmonary dysplasia but a potential reduction in the need for mechanical ventilation within 72 hours of birth when compared with standard care. CONCLUSIONS AND RELEVANCE:
Surfactant administration via a thin catheter may be an efficacious and potentially safe method; however, further studies are needed. Further studies are also needed for other methods of minimally invasive surfactant administration.
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Authors | Kiran More, Pankaj Sakhuja, Prakesh S Shah |
Journal | JAMA pediatrics
(JAMA Pediatr)
Vol. 168
Issue 10
Pg. 901-8
(Oct 2014)
ISSN: 2168-6211 [Electronic] United States |
PMID | 25089718
(Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review)
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Chemical References |
- Aerosols
- Pulmonary Surfactants
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Topics |
- Administration, Inhalation
- Administration, Intranasal
- Aerosols
- Catheterization
- Humans
- Infant, Newborn
- Infant, Premature
- Observational Studies as Topic
- Pulmonary Surfactants
(administration & dosage)
- Randomized Controlled Trials as Topic
- Respiration, Artificial
- Respiratory Distress Syndrome, Newborn
(drug therapy)
- Treatment Outcome
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