| Less invasive surfactant administration versus intubationsurfactant-
extubation: a single-center retrospective study |
Jithin CS 
, Nalina A
, shashidhar A
, Suman Rao PN
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Department of Neonatology, St. John’s Medical College Hospital, Bengaluru, India |
Correspondence:
Nalina A, Email: nalinaamuji@gmail.com
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Received: 6 February 2025 • Revised: 25 June 2025 • Accepted: 12 July 2025 |
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| Abstract |
Background
In recent years, minimally invasive methods
have been increasingly utilized for surfactant administration
in spontaneously breathing preterm infants
with respiratory distress syndrome (RDS) managed with
nasal continuous positive airway pressure owing to their
feasibility and association with improved respiratory
outcomes. However, data are limited from developing
countries on the use and effectiveness of these techniques.
Purpose
The primary objective of this study was to
evaluate the effect of less invasive surfactant administration
(LISA) and intubation-surfactant-extubation (InSurE)
techniques on the need for intubation and invasive
mechanical ventilation (MV) within 72 hours of surfactant
administration in preterm neonates with RDS. The secondary
objectives were the effects of these methods on the
need for a second surfactant dose, mortality rate, and
other preterm morbidities.
Methods
This retrospective observational study was
conducted
in Southern India over 5 years. Clinical outcomes
were analyzed in neonates with RDS at 24–34
weeks' gestation who received surfactants via the LISA or
InSurE method.
Results
A total of 98 neonates were divided into the LISA
group (n=54) and the InSurE group (n=44). The need for
intubation and MV within 72 hours was significantly lower
in the LISA versus InSurE group (18% vs. 64%, P=0.04;
relative risk, 0.28; 95% confidence interval, 0.16–0.53). The
duration of invasive ventilation was significantly shorter
in the LISA group (P<0.001). We observed no significant
intergroup differences in the need for a second surfactant
dose (17% vs. 7%, P=0.14), bronchopulmonary dysplasia
(3.7% vs. 8.8%, P=0.49), or mortality (14.5% vs. 13%, P=0.47).
Conclusion
LISA appears to be a less invasive and more
effective alternative to InSurE, demonstrating the ability
to reduce the need for intubation and invasive ventilation
within the first 72 hours as well as the duration of invasive
support in preterm infants with RDS. |
| Key Words:
InSurE, Less invasive surfactant administration,
Preterm, Respiratory distress syndrome, Surfactant |
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