Tiny Lungs, Big Decisions: A Meta-Analysis Comparing Minimally Invasive Surfactant Therapy Versus Intubation-Surfactant-Extubation in Preterm Neonates With Respiratory Distress Syndrome.

Background

Neonatal respiratory distress syndrome (NRDS) is a leading cause of morbidity and mortality in preterm infants. Minimally invasive surfactant therapy (MIST) has emerged as a promising alternative to traditional approaches, aiming to reduce mechanical ventilation while maintaining spontaneous breathing. This meta-analysis compares the efficacy and safety of MIST versus the intubation-surfactant-extubation (INSURE) method in preterm neonates with NRDS.

Methods

We searched PubMed, Scopus, and Embase for eligible studies. Two independent reviewers screened studies via the Rayyan platform. We included randomized controlled trials and observational cohorts of preterm neonates (< 37 weeks) with NRDS requiring surfactant therapy, comparing MIST and INSURE. Data extraction included study characteristics, demographics, and clinical outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane tools. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was evaluated via I 2 statistics.

Results

Then, 17 studies (n = 1931 neonates; MIST: 913, INSURE: 932) were included. Baseline characteristics were similar between groups. Mortality did not differ significantly (RR 0.62; 95% CI 0.38-1.01; p = 0.05). MIST was associated with reduced risks of bronchopulmonary dysplasia (RR 0.59; 95% CI 0.45-0.76), intraventricular hemorrhage (RR 0.66; 95% CI 0.48-0.92), patent ductus arteriosus (RR 0.75; 95% CI 0.61-0.93), and pneumothorax (RR 0.54; 95% CI 0.34-0.87). Rates of pulmonary hemorrhage and surfactant reflux were comparable. MIST also resulted in shorter oxygen day requirements (MD -2.45; p = 0.04) and need for mechanical ventilation (RR 0.54; p = 0.002). Duration of ventilation and NICU showed no significant differences.

Conclusion

MIST proved to be a safer and more effective alternative to INSURE in preterm infants with NRDS, reducing several complications and mechanical ventilation needs. These findings highlight MIST's potential as a preferred approach, warranting further research to support broader implementation.