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Original Article

Less invasive surfactant administration versus intubation-surfactant-extubation: a single-center retrospective study

Jithin CS¹  , Nalina A¹  , shashidhar A¹  , Suman Rao PN¹ 

¹Department of Neonatology, St. John’s Medical College Hospital, Bengaluru, India

Correspondence Nalina A ,Email: nalinaamuji@gmail.com

Received: February 6, 2025; Revised: June 25, 2025   Accepted: July 12, 2025.

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.

Keywords :InSurE, Less invasive surfactant administration, Preterm, Respiratory distress syndrome, Surfactant