Summary of findings 1. Surfactant administration via thin catheter (S‐TC) vs surfactant administration through an endotracheal tube (S‐ETT) in preterm infants with or at risk of respiratory distress syndrome.
| Surfactant administration via thin catheter (S‐TC) vs surfactant administration through an endotracheal tube (S‐ETT) in preterm infants with or at risk of respiratory distress syndrome | ||||||
| Patient or population: preterm infants with or at risk of respiratory distress syndrome Setting: neonatal intensive care units. Countries: Germany, Turkey, Canada, China, India, Iran, and Pakistan Intervention: surfactant administration through thin catheter (S‐TC) Comparison: surfactant administration through endotracheal tube (S‐ETT) | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | №. of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with surfactant administration through endotracheal tube (S‐ETT) | Risk with surfactant administration through thin catheter (S‐TC) | |||||
| Death or bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age | Study population | RR 0.59 (0.48 to 0.73) | 1324 (10 RCTs) | ⊕⊕⊕⊝ MODERATEa | ||
| 26 per 100 | 16 per 100 (13 to 19) | |||||
| Need for intubation within the first 72 hours | Study population | RR 0.63 (0.54 to 0.74) | 1422 (12 RCTs) | ⊕⊕⊕⊝ MODERATEa | ||
| 36 per 100 | 23 per 100 (20 to 27) | |||||
| Air leak requiring drainage | Study population | RR 0.58 (0.33 to 1.02) | 1036 (6 RCTs) | ⊕⊕⊝⊝ LOWa,b | ||
| 6 per 100 | 3 per 100 (2 to 6) | |||||
| Severe intraventricular haemorrhage (grade III or IV) | Study population | RR 0.63 (0.42 to 0.96) | 857 (5 RCTs) | ⊕⊕⊝⊝ LOWa,b | ||
| 12 per 100 | 7 per 100 (5 to 11) | |||||
| Death during first hospitalisation (all causes) | Study population | RR 0.63 (0.47 to 0.84) | 1424 (11 RCTs) | ⊕⊕⊝⊝ LOWa,b | ||
| 13 per 100 | 8 per 100 (6 to 11) | |||||
| Bronchopulmonary dysplasia (BPD) among survivors at 36 weeks' postmenstrual age | Study population | RR 0.57 (0.45 to 0.74) | 1567 (11 RCTs) | ⊕⊕⊕⊝ MODERATEa | ||
| 18 per 100 | 10 per 100 (8 to 13) | |||||
| Death or survival with neurosensory disability ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | None of the studies reported this outcome |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded by one level for serious study limitations (high risk of bias due to uncertainty about methods used to generate random sequence, conceal allocation, and mask outcome assessments) in many trials.
bDowngraded by one level for serious imprecision of effect estimate (inadequate optimal effect size and/or 95% CI around estimate consistent with substantial harm or benefit).