Turkish Archives of Pediatrics

Alternative Methods of Surfactant Administration in Preterm Infants with Respiratory Distress Syndrome: State of the Art


Division of Neonatology, Department of Pediatrics, Ankara University, Faculty of Medicine, Ankara, Turkey


Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey


Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, USA


Division of Neonatology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA


Johns Hopkins All Children’s Maternal Fetal and Neonatal Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA


Division of Neonatology, Department of Pediatrics, Health Sciences University, Ankara, Turkey


Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia


Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia

Turk Arch Pediatr 2021; 56: 553-562
DOI: 10.5152/TurkArchPediatr.2021.21240
Read: 2814 Downloads: 702 Published: 01 November 2021

For preterm infants with respiratory distress syndrome, delivery of surfactant via brief intubation (INtubate, SURfactant, Extubate; InSurE) has been the standard technique of surfactant administration. However, this method requires intubation and positive pressure ventilation. It is thought that even the short exposure to positive pressure inflations may be enough to initiate the cascade of events that lead to lung injury in the smallest neonates. In an effort to avoid tracheal intubation and positive pressure ventilation, several alternative and less invasive techniques of exogenous surfactant administration have been developed over the years. These have been investigated in clinical studies, including randomized clinical trials, and have demonstrated advantages such as a decrease in the need for mechanical ventilation and incidence of bronchopulmonary dysplasia. These newer techniques of surfactant delivery also have the benefit of being easier to perform. Surfactant delivery via pharyngeal instillation, laryngeal mask, aerosolization, and placement of a thin catheter are being actively pursued in research. We present a contemporary review of surfactant administration for respiratory distress syndrome via these alternative methods in the hope of guiding physicians in their choices for surfactant application in the neonatal intensive care unit.

Cite this article as: Erdeve Ö, Okulu E, Roberts KD, et al. Alternative methods of surfactant administration in preterm infants with respiratory distress syndrome: State of the art. Turk Arch Pediatr. 2021; 56(6): 553-562.

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