Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

161 questions · 170 findings · 38 reviews · Neonatal · Headline outcomes only

No studies found 22 · 12.9%GRADE not reported 2 · 1.2%Very low 38 · 22.4%Low 66 · 38.8%Moderate 31 · 18.2%High 11 · 6.5%

Pulse vs continuous dexamethasone therapy

Death or bronchopulmonary dysplasia at 36 weeks PMA · preterm infants at risk for bronchopulmonary dysplasia

Pulse may leads to higher death or bronchopulmonary dysplasia at 36 weeks' PMA compared with continuous dexamethasone therapy (low certainty).

1 finding from 1 review

Pulse vs continuous dexamethasone therapy

Death or abnormal neurodevelopmental outcome (various definitions) · preterm infants at risk for bronchopulmonary dysplasia

It is very uncertain whether pulse changes death or abnormal neurodevelopmental outcome (various definitions) compared with continuous dexamethasone therapy (very low certainty).

1 finding from 1 review

Lower vs higher cumulative dose dexamethasone regimen

Death or bronchopulmonary dysplasia at 36 weeks PMA · preterm infants at risk for bronchopulmonary dysplasia

Lower showed no clear difference in death or bronchopulmonary dysplasia at 36 weeks PMA compared with higher cumulative dose dexamethasone regimen (low certainty).

1 finding from 1 review

Later vs earlier initiation of dexamethasone therapy

Death or bronchopulmonary dysplasia at 36 weeks PMA · preterm infants at risk for bronchopulmonary dysplasia

Later showed no clear difference in death or bronchopulmonary dysplasia at 36 weeks' PMA compared with earlier initiation of dexamethasone therapy (low certainty).

1 finding from 1 review

Individual tailored vs continuous tapered dexamethasone regimen

Death or bronchopulmonary dysplasia at 36 weeks PMA · preterm infants at risk for bronchopulmonary dysplasia

Individual tailored showed no clear difference in death or bronchopulmonary dysplasia at 36 weeks PMA compared with continuous tapered dexamethasone regimen (low certainty).

1 finding from 1 review

Rescue high‐frequency jet ventilation vs conventional ventilation

Pulmonary air leak (new) · preterm infants with severe pulmonary dysfunction

Rescue high‐frequency jet ventilation showed no clear difference in pulmonary air leak (new) compared with conventional ventilation (low certainty).

1 finding from 1 review

Oxygen‐guided lung‐recruitment maneuver vs usual care

Bronchopulmonary dysplasia · preterm infants < 37 weeks' gestational age requiring conventional mechanical ventilation for respiratory distress syndrome

Oxygen‐guided lung‐recruitment maneuver showed no clear difference in bronchopulmonary dysplasia compared with routine care (low certainty).

1 finding from 1 review

Surfactant administration via laryngeal mask airway (S‐LMA) vs surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE)

Death or bronchopulmonary dysplasia · preterm infants with or at risk of respiratory distress syndrome

Surfactant administration via laryngeal mask airway (S‐LMA) showed no clear difference in death or bronchopulmonary dysplasia compared with surfactant administration via endotracheal tube (ETT) with the… (low certainty).

1 finding from 1 review

Surfactant administration via laryngeal mask airway (S‐LMA) vs surfactant administration through an endotracheal tube (S‐ETT)

Pulmonary air leak · preterm infants with or at risk of respiratory distress syndrome

It is very uncertain whether surfactant administration via laryngeal mask airway (S‐LMA) changes pulmonary air leak, any (during first hospitalisation) Anytime to… compared with surfactant administration via endotracheal tube (ETT) with… (very low certainty).

1 finding from 1 review

Surfactant administration via laryngeal mask airway (S‐LMA) vs surfactant administration through an endotracheal tube (S‐ETT)

Bronchopulmonary dysplasia · preterm infants with or at risk of respiratory distress syndrome

The review found no eligible studies for this question.

1 finding from 1 review

Surfactant administration via laryngeal mask airway (S‐LMA) vs no surfactant administration

Death or bronchopulmonary dysplasia · preterm infants with or at risk of respiratory distress syndrome

Surfactant administration via laryngeal mask airway (S‐LMA) showed no clear difference in death or bronchopulmonary dysplasia compared with no surfactant administration (low certainty).

1 finding from 1 review

Surfactant administration via laryngeal mask airway (S‐LMA) vs no surfactant administration

Pulmonary air leak · preterm infants with or at risk of respiratory distress syndrome

Surfactant administration via laryngeal mask airway (S‐LMA) showed no clear difference in pulmonary air leak, any (during first hospitalisation) Anytime to… compared with no surfactant administration (low certainty).

1 finding from 1 review

Surfactant administration via laryngeal mask airway (S‐LMA) vs no surfactant administration

Bronchopulmonary dysplasia · preterm infants with or at risk of respiratory distress syndrome

Surfactant administration via laryngeal mask airway (S‐LMA) showed no clear difference in bronchopulmonary dysplasia (clinical definition) among survivors compared with no surfactant administration (low certainty).

1 finding from 1 review

Surfactant administration via laryngeal mask airway (S‐LMA) vs surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE)

Pulmonary air leak · preterm infants with or at risk of respiratory distress syndrome

Surfactant administration via laryngeal mask airway (S‐LMA) showed no clear difference in pulmonary air leak, any (during first hospitalisation) Anytime to… compared with surfactant administration via endotracheal tube (ETT) with the… (low certainty).

1 finding from 1 review

Surfactant administration via laryngeal mask airway (S‐LMA) vs surfactant administration via endotracheal tube (ETT) with the intent to rapidly extubate (InSurE)

Bronchopulmonary dysplasia · preterm infants with or at risk of respiratory distress syndrome

Surfactant administration via laryngeal mask airway (S‐LMA) showed no clear difference in bronchopulmonary dysplasia (clinical definition) among survivors compared with surfactant administration via endotracheal tube (ETT) with the… (low certainty).

1 finding from 1 review

Surfactant administration via laryngeal mask airway (S‐LMA) vs surfactant administration through an endotracheal tube (S‐ETT)

Death or bronchopulmonary dysplasia · preterm infants with or at risk of respiratory distress syndrome

The review found no eligible studies for this question.

1 finding from 1 review

Surfactant treatment guided by rapid tests for surfactant deficiency vs surfactant therapy provided to preterm infants with respiratory distress syndrome diagnosed on clinical and radiologic criteria

Bronchopulmonary dysplasia · preterm infants at risk of respiratory distress syndrome

Surfactant treatment guided by rapid tests for surfactant deficiency showed no clear difference in bronchopulmonary dysplasia№ of participants: 562(3 RCTs) compared with surfactant therapy provided to preterm infants with respiratory… (low certainty).

1 finding from 1 review

Surfactant treatment guided by rapid tests for surfactant deficiency vs surfactant therapy provided to preterm infants with respiratory distress syndrome diagnosed on clinical and radiologic criteria

Bronchopulmonary dysplasia or mortality ‐ not reported · preterm infants at risk of respiratory distress syndrome

The review found no eligible studies for this question.

1 finding from 1 review

High‐dose vs standard‐dose strategies

Bronchopulmonary dysplasia/chronic lung disease · preterm infants at risk for apnea

It is very uncertain whether high‐dose changes bronchopulmonary dysplasia/chronic lung disease (BPD) at 36 weeks'… compared with standard‐dose strategies (very low certainty).

1 finding from 1 review