Neonatologist Royal Prince Alfred Hospital Camperdown, New South Wales, Australia
Background: Laryngeal mask airway surfactant administration (S-LMA) has the potential benefit of surfactant administration whilst avoiding endotracheal intubation and ventilation. Objective: To assess the effects of S-LMA either as prophylaxis or treatment (rescue) compared to placebo, no treatment, or intratracheal surfactant administration via an endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) or extubate at standard criteria (S-ETT) or via other less invasive surfactant administration (LISA) methods on morbidity and mortality in preterm infants with or at risk of respiratory distress syndrome (RDS). Design/Methods: Cochrane systematic review of randomized controlled trials (RCTs) of S-LMA compared to placebo, no treatment, or other routes of administration. Search updated December 2022. Results: We included 8 trials (7 new) recruiting 510 newborns. Five trials (333 infants) compared S-LMA with surfactant administration via ETT with InSurE. One trial (48 infants) compared S-LMA with surfactant administration via ETT with S-ETT, and 2 (129 infants) compared S-LMA with no surfactant administration. No studies comparing S-LMA with LISA techniques were identified. We found no studies of prophylactic or early S-LMA. S-LMA versus surfactant administration via ETT with InSurE: There was no effect on death or BPD (RR 1.50, 95% CI 0.27 to 8.34; 2 studies, 110 participants; low-certainty evidence). There was a reduction in the need for mechanical ventilation (RR 0.53, 95% CI 0.36 to 0.78; 5 studies, 333 infants; low-certainty evidence). However, this was limited to four studies (236 infants) using analgesia or sedation for the InSurE group. S-LMA versus surfactant administration via ETT with S-ETT: Death or BPD at 36 weeks was not reported. S-LMA may reduce the use of mechanical ventilation compared with S-ETT (RR 0.47, 95% CI 0.31 to 0.71; 1 study, 48 participants; low-certainty evidence). S-LMA versus no surfactant administration: Rescue surfactant could be used in both groups. There may be little or no difference in death or BPD at 36 weeks (RR 1.65, 95% CI 0.85 to 3.22; 2 studies, 129 participants; low-certainty evidence). There was a reduction in mechanical ventilation at any time in S-LMA compared with nasal continuous positive airway pressure without surfactant (RR 0.57, 95% CI 0.38 to 0.85; 2 studies, 129 participants; moderate-certainty evidence).
Conclusion(s): In preterm infants, S-LMA may have little or no effect on death or BPD, but may reduce the need for mechanical ventilation. This benefit is limited to trials reporting the use of analgesia or sedation in the InSurE and S-ETT groups.
