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.

研究背景：对于自主呼吸新生儿，可经细导管给予肺表面活性物质，同时保留其自主呼吸，即微创肺表面活性物质给药（Less Invasive Surfactant Administration, LISA）。另一种方案则是先对新生儿进行气管插管以完成肺表面活性物质给药，随后快速拔管，即插管-给药-快速拔管（Intubation, Surfactant, Rapid Extubation, INSURE）。本研究旨在对比LISA与INSURE的临床疗效，对相关证据进行概述。
研究方法：本研究针对既往纳入随机对照试验的荟萃分析开展伞状综述。我们于2023年7月检索了PubMed、Scopus及Web of Science数据库。由两名研究者对检索结果进行筛选，最终纳入以LISA与INSURE对比为研究主题的系统综述兼荟萃分析。由一名研究者提取数据，另一名研究者对提取的数据进行交叉验证。由两名研究者独立完成AMSTAR-2（A Measurement Tool to Assess Systematic Reviews 2）及ROBIS（Risk Of Bias In Systematic reviews）偏倚风险与质量评价。
研究结果：共纳入9篇兼具荟萃分析属性的系统综述。依据AMSTAR-2评价标准，1篇综述的质量等级为高，1篇为中等，3篇为低，4篇为极低。依据ROBIS评价工具，3篇综述的偏倚风险为低水平，6篇为高水平。相较于INSURE，LISA在预防机械通气（8/8篇纳入综述均支持该结论）、死亡或支气管肺发育不良（Bronchopulmonary Dysplasia, BPD，4/4篇纳入综述均支持该结论）、死亡（3/9篇纳入综述）以及BPD（3/9篇纳入综述）方面效果更优。
研究结论：所有纳入的系统综述及荟萃分析均显示，在机械通气需求以及死亡或BPD方面，LISA的临床效果优于INSURE。但当前已发表的相关系统综述整体质量多存在不足。未来开展的系统综述应着重关注研究报告的质量。