Background: Less invasive surfactant administration (LISA) is increasingly used to treat respiratory distress syndrome (RDS) in preterm infants, but variation in treatment effects across clinical subgroups remains unclear. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials published between 2010 and 2024 in MEDLINE, EMBASE, and CENTRAL comparing LISA with INtubation-SURfactant-Extubation (INSURE) in preterm infants with RDS. Random-effects generalized linear mixed models estimated pooled odds ratios with 95% confidence intervals. Prespecified subgroup analyses evaluated gestational age, surfactant type, antenatal corticosteroid exposure, and sedation. Results: Twenty-one trials including 2656 infants were analyzed. LISA was associated with lower odds of bronchopulmonary dysplasia, death, BPD or death, intubation or mechanical ventilation, and severe intraventricular hemorrhage. Greater benefits were observed in infants ≤ 34 weeks and those with higher antenatal steroid exposure. Conclusion: LISA improves key outcomes compared with INSURE and may provide greater benefits in specific clinical subgroups.
Sun et al. (Sun,) studied this question.