Surfactant therapy in premature babies: SurE or InSurE

Area of Science:

• Neonatal Medicine
• Respiratory Physiology
• Pediatric Critical Care

Background:

• Traditional intubation surfactant and extubation (InSurE) for respiratory distress syndrome (RDS) in preterm infants carries risks like airway trauma and barotrauma.
• Emerging noninvasive surfactant delivery methods aim to minimize these risks.
• The Surfactant-by-Exposure (SurE) technique offers a less invasive alternative to InSurE.

Purpose of the Study:

• To compare the requirement for mechanical ventilation (MV) between the SurE technique and the InSurE technique in preterm infants with RDS.
• To evaluate other clinical outcomes associated with each surfactant administration method.

Main Methods:

• A randomized trial involving preterm infants (≤34 weeks) with RDS requiring continuous positive airway pressure (CPAP).
• Infants were randomized to receive early surfactant via either the SurE (without endotracheal tube intubation) or InSurE technique within 6 hours of life.
• The primary outcome was the need for MV within the first 72 hours of life; secondary outcomes included oxygen therapy duration and hospital stay.

Main Results:

• Mechanical ventilation was required significantly less often in the SurE group (19%) compared to the InSurE group (40%) within 72 hours (P < .01).
• Infants in the SurE group experienced significantly shorter durations of oxygen therapy and hospital stays.
• The incidence of bronchopulmonary dysplasia (BPD) was also significantly lower in the SurE group.

Conclusions:

• The SurE technique for surfactant delivery in preterm neonates with RDS stabilized on CPAP effectively reduces the need for mechanical ventilation.
• This approach may also decrease the rate of bronchopulmonary dysplasia in certain vulnerable preterm infant subpopulations.
• SurE represents a promising advancement in respiratory support for preterm infants, minimizing invasive procedures and improving outcomes.