(34) Less invasive surfactant administration for treating preterm infants with Respiratory distress syndrome in Low-Middle Income countries: a scoping review

Background: Respiratory distress syndrome (RDS) accounts for 45% of all preterm deaths in LMICs compared to 2% in high-income countries. RDS is treated with liquid surfactant replacement therapy (SRT) while intubated on a mechanical ventilator. In many Low-Middle income countries (LMIC), ventilators are not readily available; less invasive surfactant administration (LISA) techniques now exist, obviating the need for mechanical ventilation. Studies from high-income countries show that LISA significantly reduces ventilator use, thus making LISA a potentially suitable SRT technique in LMICs.

Objectives: To determine the clinical use and research of LISA for treating preterm infants with RDS in LMIC.

Design/Methods: This review will include all studies published in English from peer-reviewed journals on either the thin catheter or supraglottic airway SRT in treating preterm infants with RDS in LMICs. The review will follow the Joanna Briggs Institute methodology for scoping reviews. Two reviewers will systematically screen titles, abstracts, and full-text articles independently for inclusion with Covidence. Data will be presented in tabular format or graphs, with an accompanying narrative summary.

Results: 1181 studies were identified through data extraction using key identified words with 14 studies able to have data extrapolated. The difference in hospitalization days was analyzed. Studies found either no statistically significant difference in hospitalization stay based on route of surfactant administration or less time spend in the hospital with LISA. Multiple studies reported the need for MV and other oxygen requirements after less invasive surfactant administration. Most studies found decreased need or no statistical difference for MV and overall decreased oxygen requirements for those individuals treated with less invasive surfactant administration. No studies showed utility of LISA without MV readily available. Therefore, research is limited on outcomes in areas where MV is not an option.

Conclusion: LISA effectively treats RDS, the leading cause of preterm death in LMICs. LISA can be applied without ventilation extending the utility of CPAP and non invasive respiratory support. This scoping review proves more research needs to be performed in areas where surfactant can be utilized with solely CPAP and non-invasive ventilatory support.