Comparing the Efficacy of Surfactant Administration by Laryngeal Mask Airway and Endotracheal Intubation in Neonatal Respiratory Distress Syndrome

Objectives: This study aimed to compare the efficacy of surfactant administration by laryngeal mask airway (LMA) and endotracheal intubation in the management of respiratory distress syndrome (RDS) in preterm infants. Materials and Methods: In a prospective interventional study in NICU at Al-Zahra hospital, 50 premature infants with gestational age of 33-37 weeks and birth weight of 1800 g or more who needed surfactant replacement therapy for RDS were randomly allocated to 2 groups. Twenty-five neonates in ETT group received surfactant by endotracheal intubation and the LMA were used for the administration of surfactant in 25 neonates (LMA group). Results: The mean gestational age in LMA group was 32.88±1.32 and it was 33.76±2.12 weeks in ETT group (P = 0.15). The mean RDS score was not statistically different 2 two groups, 7.68±0.80 vs. 7.24±1.17 (P = 0.79). Mechanical ventilation was needed for 1 neonate in the LMA group and 3 infants in the ETT group (P = 0.16). After surfactant administration, the mean FiO2 requirements to maintain oxygen saturation between% 88 to 92% showed a statistically significant decrease in both groups. The needed FiO2s were 0.60±0.12 and 0.57±0.12 before surfactant therapy and decreased to 0.42±0.15 and 0.36±0.10 after surfactant administration in LMA and ETT groups, respectively (P < 0.001). No choking or vomiting occurred during surfactant therapy in either group. Conclusions: Based on our findings, the LMA may be a safe and effective alternative way for surfactant administration in late preterm infants. Future multicenter studies are recommended for determining safety and efficacy of LMA in preterm infants.