Minimally Invasive Surfactant Therapy Versus InSurE in Preterm Neonates of 28-34 Weeks of Gestation with Respiratory Distress Syndrome: A Randomised Controlled Trial

Abstract

Background

Delivery of surfactant through a catheter, rather than an endotracheal tube, has been demonstrated to reduce mortality and also bronchopulmonary dysplasia, thereby reducing the requirement of intubation in the initial 72 h of life, and also decreasing the incidence of complications and mortality during hospitalisation. Evidence regarding the practicality and outcomes of this approach in resource-limited settings remains limited. To address this gap, we conducted a trial comparing the effectiveness of minimally invasive surfactant therapy (MIST) with the intubation–surfactant administration–extubation (InSurE) method in preterm infants with respiratory distress syndrome (RDS).

Objective

The objective of this study was to assess and contrast the effectiveness of MIST and InSurE method in delivering surfactant to preterm infants presenting with RDS.

Methodology

The study enrolled 192 preterm infants (28-34 weeks of gestation) who presented with RDS and met the inclusion criteria. All eligible neonates were managed with nasal continuous positive airway pressure (nCPAP), using a starting positive end-expiratory pressure of 5-6 cm H₂O. The fraction of inspired oxygen (FiO₂) was titrated to achieve target oxygen saturation levels of 90%-95%. Infants who required FiO₂ levels exceeding 40% on nCPAP to sustain these saturations within the first 6 h of life were randomised to receive surfactant therapy through either the MIST approach or the InSurE technique. Subsequent clinical outcomes were then assessed.

Results

Within the study population, infants managed with the MIST approach exhibited significantly better outcomes compared to those treated using the InSurE technique. Specifically, the MIST group showed a lower requirement for mechanical ventilation (p = .001), reduced incidence of bronchopulmonary dysplasia (p = .03), pulmonary haemorrhage (p = .02) and sepsis (p = .004). In addition, these infants required a shorter duration of CPAP support and experienced reduced overall mortality (p = .042). The length of oxygen therapy, however, remained comparable between the two groups.

Conclusion

MIST appears to be a superior alternative to the InSurE technique in preterm infants with RDS, as indicated by the notable reduction in the need for mechanical ventilation and overall mortality.