{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T15:43:12Z","timestamp":1785253392773,"version":"3.55.0"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":225,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Pediatrics"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Neonatal respiratory distress syndrome (NRDS) is a leading cause of morbidity and mortality in preterm infants. Minimally invasive surfactant therapy (MIST) has emerged as a promising alternative to traditional approaches, aiming to reduce mechanical ventilation while maintaining spontaneous breathing. This meta\u2010analysis compares the efficacy and safety of MIST versus the intubation\u2013surfactant\u2013extubation (INSURE) method in preterm neonates with NRDS.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    We searched PubMed, Scopus, and Embase for eligible studies. Two independent reviewers screened studies via the Rayyan platform. We included randomized controlled trials and observational cohorts of preterm neonates (&lt;\u200937 weeks) with NRDS requiring surfactant therapy, comparing MIST and INSURE. Data extraction included study characteristics, demographics, and clinical outcomes. Risk of bias was assessed using the Newcastle\u2013Ottawa Scale and Cochrane tools. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random\u2010effects model. Heterogeneity was evaluated via\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    statistics.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    Then, 17 studies (\n                    <jats:italic>n<\/jats:italic>\n                    = 1931 neonates; MIST: 913, INSURE: 932) were included. Baseline characteristics were similar between groups. Mortality did not differ significantly (RR 0.62; 95% CI 0.38\u20131.01;\n                    <jats:italic>p<\/jats:italic>\n                    = 0.05). MIST was associated with reduced risks of bronchopulmonary dysplasia (RR 0.59; 95% CI 0.45\u20130.76), intraventricular hemorrhage (RR 0.66; 95% CI 0.48\u20130.92), patent ductus arteriosus (RR 0.75; 95% CI 0.61\u20130.93), and pneumothorax (RR 0.54; 95% CI 0.34\u20130.87). Rates of pulmonary hemorrhage and surfactant reflux were comparable. MIST also resulted in shorter oxygen day requirements (MD \u22122.45;\n                    <jats:italic>p<\/jats:italic>\n                    = 0.04) and need for mechanical ventilation (RR 0.54;\n                    <jats:italic>p<\/jats:italic>\n                    = 0.002). Duration of ventilation and NICU showed no significant differences.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    MIST proved to be a safer and more effective alternative to INSURE in preterm infants with NRDS, reducing several complications and mechanical ventilation needs. These findings highlight MIST\u2019s potential as a preferred approach, warranting further research to support broader implementation.\n                  <\/jats:p>","DOI":"10.1155\/ijpe\/8045343","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T08:50:02Z","timestamp":1755161402000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Tiny Lungs, Big Decisions: A Meta\u2010Analysis Comparing Minimally Invasive Surfactant Therapy Versus Intubation\u2013Surfactant\u2013Extubation in Preterm Neonates With Respiratory Distress Syndrome"],"prefix":"10.1155","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8039-8778","authenticated-orcid":false,"given":"Flavio","family":"Veintemilla-Burgos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1485-7757","authenticated-orcid":false,"given":"Geovanna","family":"Minchalo-Ochoa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0345-5092","authenticated-orcid":false,"given":"Sebastian","family":"Balda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8302-1364","authenticated-orcid":false,"given":"Ivo","family":"Diaz-Djevoich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6728-2794","authenticated-orcid":false,"given":"Rodolfo","family":"Kronfle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7233-6214","authenticated-orcid":false,"given":"Matias","family":"Panchana-Lascano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3600-4051","authenticated-orcid":false,"given":"Thomas","family":"Leone-Berry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"e_1_2_13_1_2","volume-title":"StatPearls","author":"Yadav 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