Surfactant Administration in Preterm Neonates Using Laryngeal Mask Airway: A Randomized Clinical Trial

Abstract

Abstract- In this study, we aimed to compare the efficacy of laryngeal mask airway (LMA) versus endotracheal tube in the early rescue surfactant administration in premature neonates with respiratory distress syndrome (RDS). This randomized, clinical trial evaluated 60 premature neonates with RDS. Numbered envelopes randomly assigned 30 neonates to the intervention group to receive 2.5 ml/kg/dose surfactant (Curosurf) via LMA and 30 to the control group to receive 2.5 ml/kg/dose surfactant via an endotracheal tube using the INSURE technique, exclusively during the first two hours of life. There were no differences in the requirement for mechanical ventilation (23.3% vs. 20%, P=0.75), requirement for second dose surfactant (13.3% vs. 6.7%, P=0.67), bronchopulmonary dysplasia (13.3% vs. 6.7%, P=0.67), pneumothorax (6.7% vs. 0%, P=0.49), and intraventricular hemorrhage (10% vs. 10%, P=1) between neonates who received surfactant via LMA versus those who received surfactant via endotracheal tube. LMA seems to be an effective and less invasive alternative to endotracheal intubation for surfactant delivery in premature neonates with RDS.

A systematic review of surfactant delivery via laryngeal mask airway, pharyngeal instillation, and aerosolization: Methods, limitations, and outcomes

“…The lower limit for enrollment in majority of studies was 1000-1250 g since the size of currently available LMAs limits its use in extremely low birth weight babies (< 1 kg). However, studies have enrolled infants down to 800 g (smallest enrolled infant weighing 880 g 14 and 810 g. 15 2.1 | Procedure Among the eight RCTs, seven used an LMA with an inflatable cuff [15][16][17][18][19][20][21] and one used a noninflatable cuff 22 (Table 1). The LMA was placed following package insert instructions using Brains technique.…”

“…16,18 One study compared LMA SRT with the tradition method of surfactant administration through an ETT followed by mechanical ventilation 21 (as opposed to INSURE which strives for rapid extubation). Primary outcome for six studies [15][16][17][18]20,22 was need for mechanical ventilation. Primary outcome for two studies was reduction in oxygen requirement.…”

“…A systematic review and meta-analysis by Al Ali 26 consisting of six RCTs (analysis performed before publication of two RCTs 15,20 ) found that LMA SRT decreased the need for intubation and mechanical ventilation compared with CPAP alone and surfactant via an endotracheal tube. Number of surfactant doses was higher in the LMA SRT group compared to the control group.…”

“…24 Surfactant was then given in aliquots with PPV after each aliquot. 16,17,20,22 At the end of surfactant administration, PPV was further given for 1-5 min. 18,20,21,25 The LMA was then removed and the infant placed back on CPAP.…”

“…18,20,21,25 The LMA was then removed and the infant placed back on CPAP. 14,[16][17][18][19][20][21] (Video 1: https://youtu.be/9-bBTR4lN6U).…”