title: Minimally invasive surfactant therapy with a gastric tube is as effective as the intubation, surfactant, and extubation technique in preterm babies.
abstract: OBJECTIVE
  Preterm infants requiring surfactant replacement have been treated using the INSURE technique, which requires sedation and comprises tracheal intubation, surfactant instillation and extubation. However, minimally invasive surfactant therapy (MIST) does not require sedation, minimises airway injury and avoids placing positive pressure ventilation on an immature lung. This study compared the feasibility of the two techniques and the outcomes in preterm babies with respiratory distress syndrome (RDS).
  
  
  METHODS
  Preterm infants with RDS prospectively received surfactant via a gastric tube placed in the trachea by direct laryngoscopy with no sedation. Technique-related complications and respiratory outcomes were analysed.
  
  
  RESULTS
  We compared 44 patients who received MIST with a historic cohort of 31 patients who received INSURE. This showed no differences in the rate of intubation and mechanical ventilation in the first 72 h, or secondary respiratory outcomes and relevant morbidities, between the babies who received INSURE and those who received MIST. More babies in the MIST group (35%) needed a second dose of surfactant than the INSURE group (6.5%) (p < 0.0001).
  
  
  CONCLUSIONS
  Surfactant administration using MIST, with no sedation, is feasible in preterm infants with RDS. No significant differences in secondary respiratory outcomes were found between the MIST and INSURE techniques.
authors.affiliation: Division of Neonatology, University & Polytechnic Hospital La Fe, Valencia, Spain; Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Aguar
authors.forename: María
authors.initials: M
authors.lastname: Cernada
authors.forename: María
authors.initials: M
authors.lastname: Brugada
authors.forename: Ana
authors.initials: A
authors.lastname: Gimeno
authors.forename: Antonio
authors.initials: A
authors.lastname: Gutierrez
authors.forename: Máximo
authors.initials: M
authors.lastname: Vento
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000009:adverse effects; D060666:Airway Extubation / Q000009:adverse effects / Q000379:methods; D001285:Atropine / Q000008:administration & dosage / Q000009:adverse effects; D016292:Procedural Sedation / Q000009:adverse effects*; D045422:Continuous Positive Airway Pressure / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D016015:Logistic Models; D055370:Lung Injury / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010092:Oximetry / Q000379:methods; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000008:administration & dosage* / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy / Q000628:therapy*; D012189:Retrospective Studies; D013030:Spain; D013997:Time Factors
chemical_list: D000759:Adjuvants, Anesthesia; D011663:Pulmonary Surfactants; D001285:Atropine; D005283:Fentanyl
keywords: Intubation - surfactant - extubation; Minimally invasive surfactant therapy; Newborn; Respiratory distress; Surfactant