Preliminary evaluation of a new technique of minimally invasive surfactant therapy

Objective To investigate a method of minimally invasive surfactant therapy (MIST) to be used in spontaneously breathing preterm infants on continuous positive airway pressure (CPAP), evaluating the feasibility of the technique and the therapeutic benefit after MIST. Design Non-randomised feasibility study. Setting Tertiary neonatal intensive care unit. Patients and interventions Study subjects were preterm infants with respiratory distress supported with CPAP, with early enrolment of 25–28-week infants (n=11) at any CPAP pressure and fractional inspired O2 concentration (FiO2), and enrolment of 29–34-week infants (n=14) at CPAP pressure ≥7 cm H2O and FiO2 ≥0.35. Without premedication, a 16 gauge vascular catheter was inserted through the vocal cords under direct vision. Porcine surfactant (∼100 mg/kg) was then instilled, followed by reinstitution of CPAP. Measurements and results Respiratory indices were documented for 4 h following MIST, and neonatal outcomes ascertained. In all cases, surfactant was successfully administered and CPAP re-established. Coughing (32%) and bradycardia (44%) were transiently noted, and 44% received positive pressure inflations. There was a clear surfactant effect, with lower FiO2 after MIST (pre-MIST: 0.39±0.092 (mean±SD); 4 h: 0.26±0.093; p