New modalities to deliver surfactant in premature infants: a systematic review and meta-analysis

J Matern Fetal Neonatal Med. 2016 Nov;29(21):3519-24. doi: 10.3109/14767058.2015.1136997. Epub 2016 Feb 10.


Context: Surfactant is the principle treatment of respiratory distress syndrome, but the ideal method of its administration remains controversial. The intubation, surfactant administration and extubation (InSurE) method is proven to work but is invasive. The objective of this systematic review is to evaluate the efficacy and safety of the modalities of surfactant administration.

Methods: We searched MEDLINE, EMBASE and CENTRAL (inception to December 2015) for randomized trials comparing new modalities with InSurE method. The primary outcome was mortality and development of bronchopulmonary dysplasia (BPD).

Results: We screened 1837 citations and identified five unique trials were included; all were of unclear risk of bias. Four trials (400 infants) compared endotracheal catheters with InSurE, and one trial (70 infants) compared laryngeal masks (LMA) with InSurE. There was no significant difference between using endotracheal catheters compared with InSurE regarding infant mortality (risk ratio 1.05, 95% CI 0.57-1.94, 4 trials, 400 patients, p 0.87, I(2) 0%) or BPD (risk ratio 0.73, 95% CI 0.43-1.21, 4 trials, 400 patients, p 0.22, I(2) 0%). Adverse events were under-reported.

Conclusion: The use of endotracheal catheters may provide comparable results to the InSurE method. There is limited evidence on the comparative efficacy of LMA.

Keywords: Endotracheal catheter; laryngeal mask; newborn; respiratory distress syndrome.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Intubation, Intratracheal / methods*
  • Pulmonary Surfactants / administration & dosage*
  • Randomized Controlled Trials as Topic
  • Respiratory Distress Syndrome, Newborn / mortality
  • Respiratory Distress Syndrome, Newborn / therapy*


  • Pulmonary Surfactants

Supplementary concepts

  • Respiratory Distress Syndrome In Premature Infants