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Clinical decision thresholds for surfactant administration in preterm infants: a systematic review and network meta-analysisResearch in context

Authors :
Viraraghavan Vadakkencherry Ramaswamy
Tapas Bandyopadhyay
Thangaraj Abiramalatha
Abdul Kareem Pullattayil S
Tomasz Szczapa
Clyde J. Wright
Charles Christoph Roehr
Source :
EClinicalMedicine, Vol 62, Iss , Pp 102097- (2023)
Publication Year :
2023
Publisher :
Elsevier, 2023.

Abstract

Summary: Background: The ideal threshold at which surfactant administration in preterm neonates with respiratory distress syndrome (RDS) is most beneficial is contentious. The aim of this systematic review was to determine the optimal clinical criteria to guide surfactant administration in preterm neonates with RDS. Methods: The systematic review was registered in PROSPERO (CRD42022309433). Medline, Embase, CENTRAL and CINAHL were searched from inception till 16th May 2023. Only randomized controlled trials (RCTs) were included. A Bayesian random effects network meta-analysis (NMA) evaluating 33 interventions was performed. The primary outcome was requirement of invasive mechanical ventilation (IMV) within 7 days of life. Findings: 58 RCTs were included. In preterm neonates ≤30 weeks after adjusting for the confounding factor of modality of surfactant administration, an arterial alveolar oxygen tension ratio (aAO2) 30 weeks, nebulized surfactant administration at an FiO2 < 30% possibly increased the risk of IMV compared to Intubate-Surfactant-Extubate at FiO2 < 30% and 40%, and less invasive surfactant administration at FiO2 40%, certainty very low. Interpretation: Surfactant administration may be considered in preterm neonates of ≤30 weeks’ with RDS if the FiO2 requirement is ≥40%. Future trials are required comparing lower FiO2 thresholds of 30% vs. 40% and that guided by lung ultrasound. Funding: None.

Details

Language :
English
ISSN :
25895370
Volume :
62
Issue :
102097-
Database :
Directory of Open Access Journals
Journal :
EClinicalMedicine
Publication Type :
Academic Journal
Accession number :
edsdoj.8314341e9ac467390c528ccba37982c
Document Type :
article
Full Text :
https://doi.org/10.1016/j.eclinm.2023.102097