Comparison of Surfactant Administration Efficacy in the Treatment of Respiratory Distress Syndrome in Preterm Neonates: Aerosolization Versus INSURE

Respiratory distress syndrome (RDS) is considered one of the most common causes of morbidity in neonates. None of the interventions made in the last three decades to manage this disease has been able to affect the development of RDS as much as surfactant replacement.

Although the standard approach is intubation during surfactant administration, the development of alternative methods in surfactant administration, such as surfactant administration using nebulizers, has been considered that is the aim of the current study.

This randomized controlled trial was conducted on neonates with a gestational age of 28 - 32 weeks with RDS under nasal continuous positive airway pressure (nCPAP) in Beheshti Medical Center in Isfahan, Iran, within March 2018 to August 2020. The neonates requiring the fraction of inspired oxygen ≥ 0.4 for periods longer than 30 minutes to maintain oxygen saturation in the right hand within the range of 89 - 95% while being supported under continuous distending pressure ≥ 5 cm H2O were randomly divided into a control group and an intervention group. Survanta was administered in the control group through INSURE method and aerosolization using mesh nebulizers in the intervention group.

This study showed no significant difference in the arterial/alveolar oxygen ratio gradient after Survanta administration (P-value: 0.10), need for subsequent doses of surfactant (P-value: 0.771) and mechanical ventilation (P-value: 0.145), prevalence of pneumothorax (P-value: 0.50), chronic lung disease (P-value: 0.269), and high-grade intraventricular hemorrhage (P-value: 0.221), duration of nCPAP support (P-value: 0.089), or prevalence of death between the two groups (P-value: 1.00).

Since aerosolization is considered to be a noninvasive method, it is required to perform further studies to improve this approach.