Background and aims The recent trends in exogenous surfactant administration in newborns with respiratory distress syndrome (RDS) are non-invasive, to avoid intubation and mechanical ventilation (MV). The aim of the study was to evaluate the safety and effectiveness of a technique of minimally-invasive surfactant therapy (MIST) in preterm neonates compared with other techniques.

Methods Inborn preterms with gestational age (GA) less than 32 weeks requiring surfactant, received Curosurf (200 mg/kg) in three ways: 1) via a gastric tube/angiocatheter placed in the trachea by direct laryngoscopy without premedication, followed by nasal CPAP (MIST group), 2) via tracheal intubation, extubation followed by nasal CPAP (INSURE group), 3) via an endotracheal tube followed by mechanical ventilation (CONTROL group).

Results We studied 58 neonates with mean GA 26.8weeks±2.2 SD, mean birth weight 965.5g±309.8. 17 prematures (29.3%) were treated with MIST, 9 prematures (15.5%) received INSURE therapy, and 31 (53.4%) required intubation and MV. The method of surfactant administration was significantly associated with ventilation requirement (χ² = 38.21, p<<0.001, r=−0.746, 95% CI). Only 17.65% of MIST group required MV compared with 30% of INSURE group. The duration of ventilation was significantly (H_KW=28.57, p<<0.001, 95% CI) lower in MIST group (t_mean: 1.24 day±3.03 SD). The presence of hypotension after surfactant administration was significantly associated in CONTROL group (χ² = 14.79, p=0.0006, 95% CI). Also, intracranial haemorrhage, chronic lung disease and retinopathy of prematurity was significantly associated in CONTROL group (χ² = 11.54, p=0.003, r=−0.407, 95% CI), with no significant differences between MIST and INSURE groups. All deaths (10.34%) were recorded in CONTROL group.

Conclusions MIST is a safe and potentially effective alternative to other techniques of surfactant administration, but further study is needed on a larger number of patients.