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CC BY-NC-ND 4.0 · Am J Perinatol 2024; 41(02): 211-227
DOI: 10.1055/a-2001-9139
Clinical Opinion

Less Invasive Surfactant Administration: A Viewpoint

Srinivasan Mani 
1   Department of Pediatrics, University of Toledo, Toledo, Ohio
,
Munmun Rawat
2   Department of Pediatrics, University at Buffalo, Buffalo, New York
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Abstract

The standard of care in treating respiratory distress syndrome in preterm infants is respiratory support with nasal continuous positive airway pressure or a combination of continuous positive airway pressure and exogenous surfactant replacement. Endotracheal intubation, the conventional method for surfactant administration, is an invasive procedure associated with procedural and mechanical ventilation complications. The INSURE (intubation, surfactant administration, and extubation soon after) technique is an accepted method aimed at reducing the short-term complications and long-term morbidities related to mechanical ventilation but does not eliminate risks associated with endotracheal intubation and mechanical ventilation. Alternative methods of surfactant delivery that can overcome the problems associated with the INSURE technique are surfactant through a laryngeal mask, surfactant through a thin intratracheal catheter, and aerosolized surfactant delivered using nebulizers. The three alternative methods of surfactant delivery studied in the last two decades have advantages and limitations. More than a dozen randomized controlled trials have aimed to study the benefits of the three alternative techniques of surfactant delivery compared with INSURE as the control arm, with promising results in terms of reduction in mortality, need for mechanical ventilation, and bronchopulmonary dysplasia. The need to find a less invasive surfactant administration technique is a clinically relevant problem. Before broader adoption in routine clinical practice, the most beneficial technique among the three alternative strategies should be identified. This review aims to summarize the current evidence for using the three alternative techniques of surfactant administration in neonates, compare the three techniques, highlight the knowledge gaps, and suggest future directions.

Key Points

  • The need to find a less invasive alternative method of surfactant delivery is a clinically relevant problem.

  • Clinical trials that have studied alternative surfactant delivery methods have shown promising results but are inconclusive for broader adoption into clinical practice.

  • Future studies should explore novel clinical trial methodologies and select clinically significant long term outcomes for comparison.

Keywords

less invasive surfactant administration - thin catheter technique - aerosolized surfactant - minimally invasive surfactant therapy - surfactant administration through laryngeal supraglottic airway


Publication History

Received: 05 September 2022

Accepted: 12 December 2022

Accepted Manuscript online:
20 December 2022

Article published online:
15 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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