A Prospective Cohort Study on Less Invasive Surfactant Administration (LISA) in Preterm Neonates with Respiratory Distress Syndrome

Modified natural surfactants have been in clinical use for the treatment of respiratory distress syndrome (RDS) for about 30 years. [1,2] Replacement therapy with exogenous surfactant preparations dramatically reduced RDS related morbidity and mortality thus becoming the most effective evidence-based therapy for RDS. In the first decade of replacement therapy, surfactant bolus administration during mechanical ventilation was the method of choice. In 1990s, continuous positive airway pressure (CPAP) became increasingly popular and small catheter surfactant delivery method was described [3]. However, it was believed that at least a short interval of positive pressure ventilation was needed to move surfactant from the trachea to the lung periphery, resulting in the development of the Intubate, Surfactant, Extubate to CPAP (INSURE) technique [4]. However, with INSURE, laryngoscopy and intubation with a standard large diameter endotracheal tube are performed accompanied by analgesia and sedation. Following surfactant bolus administration, the infants are either ventilated with bag-tube ventilation (BTV) and/or connected to a mechanical ventilator delivering gas volumes with the help of positive pressure at least for a short interval. With evolving management paradigms, CPAP became more popular for premature infants. However, CPAP failure because of RDS especially in the most immature infants prompted search for a method for delivering surfactant in a less invasive manner [5].