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Efficacy and safety of minimally invasive surfactant administration in preterm infants with neonatal respiratory distress syndrome: a systematic review and meta-analysis
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  • Xiao Hong Wu,
  • Zhoushan Feng,
  • Juan Kong,
  • Yiyu Lai,
  • Chunhong Jia,
  • Zhanyuan Xu,
  • Fan Wu,
  • Qiliang Cui,
  • Yaoyong Chen
Xiao Hong Wu
Guangzhou Medical University

Corresponding Author:[email protected]

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Zhoushan Feng
Sun Yat-sen University Sixth Affiliated Hospital
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Juan Kong
Guangzhou Medical University
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Yiyu Lai
Guangzhou Medical University
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Chunhong Jia
Guangzhou Medical University
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Zhanyuan Xu
Guangzhou Medical University
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Fan Wu
Guangzhou Medical University
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Qiliang Cui
Guangzhou Medical University
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Yaoyong Chen
Guangzhou Medical University
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Abstract

Abstract Background: The effects of minimally invasive surfactant administration (MISA) in preterm infants with neonatal respiratory distress syndrome (NRDS) are unclear. Methods: We searched randomized controlled trials (RCTs) and compared MISA techniques with intubation for surfactant delivery in preterm infants with NRDS in PubMed, Embase, Cochrane Library, and Web of Science. Results: Thirteen RCTs (1931 infants) were included in the meta-analysis. The use of MISA techniques decrease the incidence of bronchopulmonary dysplasia (BPD) at 36 weeks, pneumothorax, and hemodynamically significant patent ductus arteriosus (hsPDA) (Risk Ratio(RR) : 0.59, 95% confidence interval (CI) : 0.46 to 0.75, p < .0001; RR : 0.60, 95% CI : 0.39 to 0.93, p= .02 and RR : 0.88, 95% CI : 0.78 to 1.00, p= .04, respectively). In addition, infants in the MISA group required less mechanical ventilation within 72 h of life or during hospitalization (RR : 0.60, 95% CI : 0.48 to 0.75, p< .00001 and RR : 0.64, 95% CI : 0.49 to 0.82, p = .0005, respectively) compared with infants in the control group. However, the rate of surfactant reflux was higher in the MISA group than that in the control group (RR : 2.12, 95% CI : 1.37 to 3.29, p = .0008). There were no significant differences in mortality and other outcomes beteween the MISA group and the control group. Conclusions: The administration of surfactant with MISA techniques could lower the requirement for mechanical ventilation, and decrease the incidence of BPD at 36 weeks, pneumothorax, and hsPDA.
09 Feb 2021Submitted to Pediatric Pulmonology
10 Feb 2021Submission Checks Completed
10 Feb 2021Assigned to Editor
11 Feb 2021Reviewer(s) Assigned
26 Feb 2021Review(s) Completed, Editorial Evaluation Pending
03 Mar 2021Editorial Decision: Revise Major
01 May 20211st Revision Received
03 May 2021Submission Checks Completed
03 May 2021Assigned to Editor
03 May 2021Reviewer(s) Assigned
12 May 2021Review(s) Completed, Editorial Evaluation Pending
16 May 2021Editorial Decision: Revise Minor
30 May 20212nd Revision Received
31 May 2021Submission Checks Completed
31 May 2021Assigned to Editor
31 May 2021Reviewer(s) Assigned
31 May 2021Review(s) Completed, Editorial Evaluation Pending
03 Jun 2021Editorial Decision: Accept