Overview of the Effectiveness of Different Surfactant Administration Methods: An Umbrella Review of Meta-Analyses
In brief
Less invasive surfactant administration lowers BPD and mortality versus intubation
An umbrella review of 19 meta-analyses found that the less invasive surfactant administration (LISA) technique consistently reduced bronchopulmonary dysplasia, combined BPD or death, need for mechanical ventilation, pneumothorax/air leaks and intraventricular hemorrhage compared with conventional intubation, and also cut mortality versus both intubation and InSurE. Evidence for laryngeal mask airway use was mixed, so LISA remains the preferred method while further trials clarify the role of alternative approaches.
- Journal
- Pediatric pulmonology (Q1)
- Published
- 1 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Anita Hartikainen, Panu Kiviranta, Kati Räsänen, Ilari Kuitunen
- PMID
- 42606389
- DOI
- 10.1002/ppul.71799
Why clinicians should know about it
- Picked for Neonatology (paper of the day, 23 August 2026): Umbrella review of surfactant administration methods
- Picked for Otorhinolaryngology (top studies of the week, 23 August 2026): Not related to ENT clinical practice
Abstract
OBJECTIVE: To compare the effectiveness of various surfactant administration methods. METHODS: We conducted an umbrella review of meta-analyses conducted on randomized controlled trials. The search was conducted in March 2024 in four databases. Two authors screened the results and extracted the data. Review quality was assessed according to AMSTAR-2. Traffic-light plots were used to summarize the effectiveness of different administration methods. RESULTS: Nineteen meta-analyses comprising 247 comparisons were included. The most evaluated method was less invasive surfactant administration (LISA), across 16 comparisons versus InSurE and intubation. LISA significantly reduced risks of bronchopulmonary dysplasia (BPD), BPD or death combined, mechanical ventilation, pneumothorax/air leaks, and intraventricular hemorrhage (IVH) versus intubation; it also lowered mortality versus InSurE and intubation. No IVH difference was seen between LISA and InSurE. Five comparisons (17 outcomes) assessed laryngeal mask airway (LMA) against intubation and InSurE. LMA reduced subsequent intubation or mechanical ventilation versus intubation. Findings on post-surfactant FiO2 were inconsistent. No differences were observed in mortality, BPD (or death), IVH, additional surfactant needs, pneumothorax, patent ductus arteriosus, desaturation, reflux, procedure failure, bradycardia, or home oxygen use between LMA and intubation, nor in BPD outcomes versus InSurE. CONCLUSION: Based on recent meta-analyses, LISA appears to be the most effective and extensively evaluated surfactant administration method in head-to-head comparisons. Future research should clarify LMA's role and establish a definitive method hierarchy; currently, LISA remains the preferred choice when feasible.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.