Effectiveness of Surfactant Administration in Two Different Methods (MIST, INSURE) on the Short-Term Outcome of Preterm Infants With Respiratory Distress Syndrome: A Randomized Clinical Trial.

Abstract

Introduction: Preterm birth (< 37 weeks) causes high neonatal mortality, with respiratory distress syndrome (RDS) as a major complication due to surfactant deficiency. Surfactant administered via several methods. This study compares effectiveness and complications of two different methods of surfactant therapy.

Methods: This randomized clinical trial was conducted involving two groups of a total of 80 neonates aged 28-34 weeks who, based on clinical conditions, required surfactant administration. In the INSURE method, the infant is first intubated with an appropriate size endotracheal tube, subsequently, surfactant is administered in a controlled manner using a feeding catheter and 20 cmH₂O positive pressure ventilation (PPV) and 5 cmH₂O positive end expiratory pressure (PEEP) with a T-piece device, and in the MIST method, while the infant is on nasal CPAP with a PEEP of 5 cmH₂O, a thin feeding catheter is inserted into the trachea and Surfactant is then slowly administered at the same dose, the catheter is immediately removed and nasal CPAP is continued. And the outcomes included the duration of respiratory support, need for surfactant re-administration, mechanical ventilation and complications such as pulmonary hemorrhage, pneumothorax evaluated.

Results: indicated that none of the infants in the MIST group developed pneumothorax, required a second dose of surfactant, or underwent mechanical ventilation, compared with 12.8% (p = 0.055), 10.3% (p = 0.123), and 10.3% (p = 0.123), respectively, in the INSURE group. similarly, the duration of CPAP support and oxygen therapy did not differ significantly between the groups.

Conclusions: Although many of the findings did not reach statistical significance, MIST appears to be associated with potentially important clinical benefits that should not be overlooked. Further studies with larger sample sizes are warranted to confirm these findings.