Minimally or less invasive surfactant replacement therapy in neonates: A narrative review

Surfactant replacement therapy is a major cornerstone in the successful management of neonates with respiratory distress syndrome. Until recently, the INtubate, SURfactant, Extubate protocol was the best a trade-off achieved to deliver the surfactant to the air exchanging respiratory epithelium against the barotrauma of prolonged intubation and ventilation. Minimal or Less Invasive Surfactant Therapy (MIST or LISA) was adapted in clinical practice as a gentler and a gentler way of delivering surfactant. LISA or MIST is associated with a significant reduction in the oxygen days and chronic lung disease, intraventricular hemorrhage of grade 2 or above, retinopathy of prematurity and other key neonatal outcomes. This translates into shortened neonatal intensive care unit stay and a significant reduction in the stress levels of neonatal nurses, parents, and caregivers. This procedure needs to be performed by skilled professionals with appropriate training to achieve the desired results.