Surfactant Administration Via Thin Catheter In Preterm Infantants With Respiratory Distress Syndrome:A Meta Analysis

Background: Neonatal respiratory distress syndrome is more common in preterm infants.The smaller gestational age is, the higher incidence rate is. Respiratory distress syndrome(RDS) and its complications are major contributors to morbidity and mortality in prematurity. Some clinical trials have indicated that surfactant administration via thin catheter in preterm infantants in spontaneously breathing with Respiratory Distress Syndrome had a lower rate of mechanical ventilation,bronchopulmonary dysplasia, mortality and other short and long-term complications.but its efficacy and safety have not been confirmed by Meta analysis.Objective: In order to evaluate the safety and efficacy of minimally invasive surfactant administration using a thin catheter in preterm infants with or at risk for respiratory distress syndrome.Methods:We searched some Chinese date base such as Chinese Biomedical Literature Service System-Sino Med(CBM), China National Knowledge Infrastructure(CNKI), Wanfang database and Chongqing VIP Chinese scientific and technical journals database with the key words preterm infants,respiratory distress syndrome,pulmonary surfactant,and searched separately English databases: EMBASE, Pub Med, Clinical Trials, Cochrane Library, Cochrane Central Register of Controlled Trials(CENTRAL), WEB OF SCIENCE with the search formula(((((Respiratory Distress Syndrome) OR Hyaline Membrane Disease) AND pulmonary surfactant) AND infant,newborn [Me SH])).Retrieval time are from building a database to March 2016, while the use of manual retrieval, document traceability and other methods. Randomized or quasi randomized controlled trials of preterm infants in spontaneously breathing who were given surfactant via thin catheter for respiratory distress syndrome are included in this Meta-analysis. Risk ratios and 95% confidence intervals in count data and weighted mean difference in measurement data are reported when appropriate. The bias of the each included study was evaluated according to the risk assessment tools recommended by the Cochrane review manual version 5.0 and above,and reporting bias was assesssed by funnel plot of standard error by log risk ratio.with comprehensive meta analysis version 3.0.Meta-analysis was conducted using comprehensive meta analysis version 3.0.Results: Five randomized trials were included in this meta-analysis of 759 preterm infants. The meta-analysis suggested that the MV requirement in the first 72 hours of birth(RR=0.711,95%CI : 0.594 ~ 0.850, P=0.000), bronchopulmonary dysplasia rate(RR=0.708,95%CI:0.512~0.850,P=0.036),the rate of bronchopulmonary dysplasia or death(RR=0.609,95%CI:0.609~0.992,P=0.043) were significantly lower in the surfactant administration via thin catheter group when compared with the In Sur E group.Mean duration of both continuos positive airway Pressure and mechanical ventilation( MD=-2.744 d, 95%CI :-4.410 ~-1.077, P=0.001), supplemental O2 duration(MD=-6.677 d,95%CI:-11.220~-2.135,P=0.004)were significantly shorter in the surfactant administration via thin catheter group. There were no significant differences in the incidence of the second attempt or above to apply surfactant, mean duration of Mechanical Ventilation,mortality, pneumothorax, intra ventricular haemorrhage grade 3 or 4, surgical treatment of necrotising enterocolitis or focal intestinal perforation, laser therapy or cryotherapy of retinopathy,periventricular leukomalacia,surgical treatment of patent ductus arteriosus between the surfactant administration via thin catheter group and the In Sur E group.Conclusion: According to the inclusion criteria, current evidence demonstrated that surfactant administration via thin catheter in preterm infantants with Respiratory Distress Syndrome is safe and effective.