Effectiveness and feasibility of orogastric tube for surfactant delivery in moderate or very preterm neonates with respiratory distress syndrome: an open-label randomized controlled trial

To assess the feasibility and effectiveness of administering surfactant via an orogastric feeding tube used as a thin tracheal catheter, compared with the Intubation-Surfactant-Extubation (InSurE) method, in preterm neonates with respiratory distress syndrome (RDS). This was hospital-based, randomized controlled trial. The intervention group (Group A) received surfactant via an orogastric tube with direct laryngoscopy while maintaining continuous positive airway pressure (CPAP) therapy. The control group (Group B) received surfactant using the standard InSurE technique. Data collected included demographic details, feasibility criteria, clinical condition, respiratory support requirements, complications, and final outcomes. Baseline characteristics were comparable between groups. All 120 infants in the intervention group received surfactant via the feeding tube successfully on the first attempt, with uninterrupted administration, no premedication, no conversions to intubation, no procedure-related bradycardia, desaturation, or apnea, and no significant regurgitation. The need for mechanical ventilation was significantly lower in the feeding-tube group compared with InSurE (22 vs. 35; P = .049, relative risk 0.74). The mean duration of oxygen therapy, hospital stay, rates of bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) (grade II or higher), air leaks, sepsis, and mortality did not differ significantly between groups. Surfactant administration via an orogastric feeding tube inserted into the trachea is feasible, safe, and as effective as the InSurE method in preterm neonates of 28-34 weeks' gestation. This low-cost, universally available alternative has important implications for improving access to surfactant therapy in resource-limited settings of tropical low- and middle-income countries (LMICs).