Surfactant nebulization (SN) may offer a safe alternative for surfactant administration in respiratory distress syndrome of preterm infants.

To evaluate the efficacy of SN for the prevention of early intubation.

Medline, Embase, The Cochrane Library, clinicaltrials.gov, published abstracts, and references of relevant articles were searched through March 23, 2021.

Randomized clinical trials of preterm infants <37 weeks’ gestation comparing SN with noninvasive respiratory support or intratracheal surfactant application.

Two reviewers extracted data and assessed risk of bias from included studies separately and blinded. Data were pooled by using a fixed-effects model. Subgroups (gestational age, type of nebulizer, surfactant type, and dosage) were evaluated. Primary outcome was intubation rate at 72 hours after birth.

Nine studies recruiting 1095 infants met inclusion criteria. SN compared with standard care significantly reduced intubation rate at 72 hours after birth (226 of 565 infants [40.0%] vs 231 of 434 infants [53.2%]; risk ratio [RR]: 0.73, 95% confidence interval [CI]: 0.63–0.84; number needed to treat: 8; 95% CI: 5–14]). Prespecified subgroup analysis identified important heterogeneity: SN was most effective in infants ≥28 weeks' gestation (RR: 0.70, 95% CI: 0.60–0.82), with a pneumatically driven nebulizer (RR: 0.52, 95% CI: 0.40–0.68) and in infants receiving ≥200 mg/kg and animal-derived surfactant (RR: 0.63, 95% CI: 0.52–0.75). No differences in neonatal morbidities or mortality were identified.

Quality of evidence was low owing to risk of bias and imprecision.

SN reduced the intubation rate in preterm infants with a higher efficacy for specific subgroups. There was no difference in relevant neonatal morbidities or mortality.

表面活性剂雾化 (SN) 可能为早产儿呼吸窘迫综合征中的表面活性剂给药提供一种安全的替代方法。

评估SN预防早期插管的疗效。

检索了 Medline、Embase、Cochrane 图书馆、clinicaltrials.gov、已发表的摘要和相关文章的参考文献，直至 2021 年 3 月 23 日。

比较 SN 与无创呼吸支持或气管内表面活性剂应用的 <37 周妊娠早产儿的随机临床试验。

两名评价员分别从盲法和盲法中提取数据并评估了纳入研究的偏倚风险。使用固定效应模型合并数据。评估了亚组（胎龄、雾化器类型、表面活性剂类型和剂量）。主要结局是出生后 72 小时的插管率。

九项招募了 1095 名婴儿的研究符合纳入标准。SN 与标准护理相比，在出生后 72 小时显着降低插管率（565 名婴儿中的 226 名 [40.0%] vs 434 名婴儿中的 231 名 [53.2%]；风险比 [RR]：0.73，95% 置信区间 [CI]：0.63 –0.84；需要治疗的人数：8；95% CI：5–14]）。预先指定的亚组分析确定了重要的异质性：SN 在 ≥ 28 周妊娠的婴儿中最有效（RR：0.70，95% CI：0.60–0.82），使用气动雾化器（RR：0.52，95% CI：0.40–0.68）接受≥200 mg/kg 和动物源性表面活性剂的婴儿（RR：0.63，95% CI：0.52–0.75）。未发现新生儿发病率或死亡率的差异。

由于存在偏倚和不精确的风险，证据质量较低。

SN 降低了早产儿的插管率，对特定亚组的疗效更高。相关新生儿发病率或死亡率没有差异。