Comparison of Minimally Invasive Surfactant Therapy and Intubation-surfactant Administration-extubation in Premature Neonates with Respiratory Distress Syndrome.

Objectives: Surfactant therapy is an established treatment for neonatal respiratory distress syndrome (RDS). We sought to compare two administration techniques, intubation-surfactant administration-extubation (INSURE) and minimally invasive surfactant therapy (MIST), for efficacy and safety in premature neonates with RDS.

Methods: In this randomized clinical trial, premature neonates with RDS admitted to a neonatal intensive care unit in Iran from July to December 2020 were randomly assigned either to INSURE or MIST. In the MIST group, the surfactant was administered during spontaneous breathing via a thin vascular catheter without intubation. In the INSURE group, infants were intubated, surfactant administered, and then extubated. The key outcomes were the frequency of surfactant administration, duration of oxygen support, need for mechanical ventilation in the first 72 hours, and complications arising.

Results: The baseline characteristics of the studied premature neonates (N = 82) were similar between the INSURE (n = 44) and MIST (n = 38) groups. The surfactant treatment time was much shorter for the INSURE group (10.5 ± 17.0 minutes) than for the MIST group (42.0 ± 42.5 minutes; p < 0.001). All infants received the first dose of surfactant, and requiring a second dose was obeserved in 17 (38.6%) in the INSURE group and 18 (47.4%) in the MIST group (p = 0.400). There were no significant differences between the groups in the incidence of intraventricular hemorrhage, bronchopulmonary dysplasia, patent ductus arteriosus, pneumothorax, pulmonary hemorrhage, or disseminated intravascular coagulation. The duration of nasal continuous positive airway pressure and the need for mechanical ventilation were also similar.

Conclusions: Both INSURE and MIST techniques are effective and safe for administering surfactant therapy to premature infants with RDS, with no significant differences in outcomes or complications.