title: Technique for intrapartum administration of surfactant without requirement for an endotracheal tube.
abstract: OBJECTIVE
  To evaluate the feasibility and safety of administering surfactant into the nasopharynx during delivery, thus permitting the baby to aspirate the solution into the fluid-filled airway as an air-fluid interface is established. This process avoids the endotracheal intubation (ETI) and positive pressure ventilation (PPV) usually associated with prophylaxis, thus avoiding the pulmonary barotrauma associated with the conventional method of surfactant administration.
  
  
  METHODS
  In all, 23 neonates weighing 560 to 1804 g and born at 27 to 30 weeks had their nasopharyngeal airways suctioned and then 3.0-4.5 ml Infasurf instilled into the nasopharynx before delivery of the shoulders. Continuous positive airway pressure (CPAP) of 10 cmH(2)O was administered by mask as the babies initiated breathing. Nasal CPAP at 6 cmH(2)O was then continued for a minimum of 48 hours.
  
  
  RESULTS
  In all, 13 of 15 babies delivered vaginally were weaned quickly to room air and required no further surfactant or endotracheal intubation for RDS. Five of eight babies delivered by C-section required subsequent endotracheal intubation soon after birth and two received subsequent endotracheal tube surfactant.
  
  
  CONCLUSIONS
  Nasopharyngeal surfactant instillation at birth appears to be relatively safe and simple to accomplish, especially for vaginal births. A large randomized clinical trial will be required to determine the efficacy of this technique when compared to prophylaxis by endotracheal intubation and to nCPAP alone.
authors.affiliation: Department of Pediatrics, University of Virginia, Box 800386, Charlottesville, VA 22908, USA.
authors.forename: John
authors.initials: J
authors.lastname: Kattwinkel
authors.forename: Melinda
authors.initials: M
authors.lastname: Robinson
authors.forename: Barry T
authors.initials: BT
authors.lastname: Bloom
authors.forename: Paula
authors.initials: P
authors.lastname: Delmore
authors.forename: James E
authors.initials: JE
authors.lastname: Ferguson
mesh_terms: D001688:Biological Products / Q000008:administration & dosage*; D045422:Continuous Positive Airway Pressure; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007322:Instillation, Drug; D007442:Intubation, Intratracheal; D008297:Male; D009305:Nasopharynx; D011247:Pregnancy; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*
chemical_list: D001688:Biological Products; C117342:calfactant