Administration of Surfactant via Laryngeal Mask Airway in the Treatment of Respiratory Distress Syndrome: Experience at a Welsh Tertiary Neonatal Unit

Kanodie-Adibji B and Xing JK

Published on: 2025-03-30

Abstract

Background Current international recommendations for the treatment of preterm infants with respiratory distress syndrome (RDS) suggest early administration of surfactant and continuation of non-invasive modalities.

Laryngeal mask airway surfactant (LaMAS) without laryngoscopy is a promising method. Limited studies available regarding LaMAS included moderately preterm babies, at least 28 weeks gestational age, weighing greater than 1000g.

Type of Study: Prospective cohort study

Method/Subjects: We introduced LaMAS to treat eligible babies with RDS, who were ≥ 25 weeks gestation, with birth weight ≥ 750 grams. The sizes of LMA used ranged from 0 to 1. We present the outcomes of the 26 babies treated in one year between from March 2024.

Eligibility Criteria: Infants ≥ 25 weeks gestation and birth weight ≥ 750 grams with clinical and/or radiological evidence of RDS. Infants were excluded if they had severe respiratory acidosis, pneumothorax or imminent need for intubation. Successful insertion of LMA, delivery of surfactant, adverse events, clinical response as well as intubation within 72 hours were documented.

Results: The median (range) gestational age and birthweight were 34 weeks (25+5 to 40+5) and 2464g (770 to 4115g). There was a 100% success rate in LMA insertion, 96 % of which were on first attempt. The median (range) postnatal age at surfactant administration was 7.8 hours (0.6 to 22.5 hours).

Twenty-two (85%) had significant improvement within two hours of treatment while four were eventually intubated.

Discussion: This procedure is easy to perform, effective and is associated with minimal adverse events. This may be the ideal way to give early surfactant in preterm babies > 750g, who are relatively stable on CPAP to avoid intubation. For preterm babies who require surfactant in non-tertiary neonatal units, LaMAS can be a good option of treating RDS to maintain non-invasive respiratory support, thereby avoiding inter-hospital transfer for invasive ventilation.