A Systematic Review: Is LISA as Effective as Endotracheal Tube Surfactant Administration in Reducing Bronchopulmonary Dysplasia in Preterm Infants?

Background: Surfactant therapy is traditionally delivered via endotracheal tube during mechanical ventilation. Newer methods, such as aerosol, thin catheter, and laryngeal mask airway administration, show potential for reducing bronchopulmonary dysplasia (BPD) compared to standard approaches like intubate-surfactant-extubate (INSURE). This review evaluates whether less-invasive surfactant administration is as effective as endotracheal intubation in reducing BPD incidence in preterm infants.

Methods: A systematic review was conducted in September of 2024 using MEDLINE, Embase, and Web of Science. Studies comparing LISA with INSURE, mechanical ventilation, or both regarding BPD outcomes were included. Risk of bias was assessed using the Johanna Briggs Institute critical appraisal tools. Data were synthesized using a study characteristic table.

Results: Fifty-eight studies were reviewed involving 26 to 7533 infants (gestational ages 22 to 41 weeks). Of these, 43 found no significant difference in BPD rates between the compared methods, while 15 reported lower BPD rates with LISA.

Discussion: Although BPD reduction with LISA was not statistically significant, LISA offered benefits such as fewer ventilation days, lower intubation rates, reduced intubation-associated risks, and less need for premedication. Limitations included the predominance of retrospective studies, making exclusion of confounding variables difficult, and small sample sizes in both supportive and non-supportive studies, which may have hindered statistical significance.