Supplementary Material for: Less invasive surfactant administration (LISA) compared to intubation surfactant rapid extubation (INSURE) method in preterm neonates - an umbrella review

Introduction: In spontaneously breathing neonates, surfactant can be administered via thin catheter while enabling the own breathing (less invasive surfactant administration (LISA)). Alternatively, the neonate is intubated for surfactant delivery (Intubation, Surfactant, Rapid Extubation (INSURE)). Thus, the aim was to provide an overview of the efficacy of the LISA compared to INSURE. Methods: We performed an umbrella review of previous meta-analyses including randomized controlled trials. We searched PubMed, Scopus, and Web of Science in July 2023. Two authors screened the search results and systematic reviews with meta-analyses that focused on LISA vs INSURE were included. One author extracted, and another author validated the extracted data. AMSTAR-2 and ROBIS evaluations were performed by two authors independently. Results: A total of 9 systematic reviews with meta-analyses were included. The quality according to AMSTAR-2 was high in one, moderate in one, low in three, and critically low in four. According to ROBIS the risk of bias was low in three and high in six of the reviews. LISA was more effective than INSURE in preventing mechanical ventilation (8/8 reviews), death or BPD (4/4 reviews), death (3/9 reviews) and BPD (3/9 reviews). Conclusions: All the included systematic reviews and meta-analyses reported LISA to be more effective than INSURE in terms of need for mechanical ventilation and death or BPD. However, the quality of the published systematic reviews has been mostly deficient. Future systematic reviews should focus on reporting quality.

引言：对于自发呼吸的新生儿，可通过细导管给予肺表面活性物质（surfactant），同时保留其自主呼吸，即微创表面活性剂给药（less invasive surfactant administration, LISA）。另一种临床方案为先为新生儿实施气管插管以完成肺表面活性物质给药，随后快速拔管，即气管插管-表面活性剂给药-快速拔管（Intubation, Surfactant, Rapid Extubation, INSURE）技术。本研究旨在对比LISA与INSURE的疗效并进行综述。
方法：本研究针对既往纳入随机对照试验的Meta分析开展伞状综述（umbrella review）。我们于2023年7月检索了PubMed、Scopus及Web of Science三大数据库。由2名研究者独立筛选检索结果，最终纳入聚焦LISA与INSURE对比的Meta分析类系统评价。由1名研究者提取研究数据，另1名研究者对提取的数据进行交叉验证。另有2名研究者独立采用AMSTAR-2与ROBIS工具分别完成研究质量评价与偏倚风险评估。
结果：本研究共纳入9项Meta分析类系统评价。依据AMSTAR-2评分，其中1项评价质量为高，1项为中等，3项为低，4项为极低。根据ROBIS评估结果，3项研究的偏倚风险为低水平，6项为高水平。相较于INSURE，LISA在预防机械通气（8/8项综述）、死亡或支气管肺发育不良（bronchopulmonary dysplasia, BPD）、死亡（3/9项综述）及支气管肺发育不良（3/9项综述）方面均更具优势。
结论：所有纳入的Meta分析类系统评价均显示，在机械通气需求、死亡或支气管肺发育不良方面，LISA的疗效均优于INSURE。但现有已发表的系统评价质量大多存在不足。未来的系统评价研究应着重提升研究报告的质量。