Feasibility of Surfactant Delivery via Preterm Supraglottic Airways in Infants with Birth Weights of 800–1500 g

OBJECTIVE: To assess feasibility and safety of airway management and surfactant administration using newly developed preterm-sized supraglottic airways (SAs) in infants with respiratory distress syndrome and birth weight 750 -1500 g. STUDY DESIGN: This investigator-initiated, single-arm interventional feasibility study was conducted in a level III neonatal intensive care unit at Phu San Hanoi Hospital (35,000 annual births). Infants with birth weights 750-1500 g were enrolled after parental consent. Surfactant was administered via preterm-sized SAs. The primary outcome was successful placement within 2 attempts. Video recordings were used to assess procedure characteristics and physiologic stability by continuous pulse oximetry. Data were summarized descriptively and compared for infants with weights of <1000 vs 1000-1500 g. RESULTS: decreased from 0.40 to 0.25 one hour post-procedure (P <0.001). Three desaturations (<60%) and one bradycardia (<60 beats per minute) occurred; no other procedure-related serious adverse events were reported. No differences in response or adverse events were found in infants with birth weight <1000g. CONCLUSIONS: Use of preterm sized SAs for surfactant delivery in infants weighing 800-1500 g was feasible and well tolerated. Large randomized controlled trials are needed to compare its efficacy and safety with conventional administration of surfactant.