MIST versus INSURE: Superior outcomes in surfactant administration for preterm neonates with RDS

Minimally invasive surfactant therapy (MIST) is increasingly adopted in neonatal care as an alternative to the INSURE (Intubation-Surfactant-Extubation) method for managing respiratory distress syndrome (RDS) in preterm infants. MIST reduces intubation-related complications and facilitates surfactant administration without invasive ventilation. This study aimed to compare the complications and outcomes of surfactant delivery via MIST versus INSURE in preterm infants with RDS.

In this retrospective study, we analyzed data from 513 preterm infants (gestational age: 28-34 weeks) with RDS admitted to Ghaem Hospital, Mashhad, Iran, between 2019 and 2025. Outcomes were compared between 257 infants treated with INSURE and 256 treated with MIST. Data on gestational age, birth weight, Apgar scores (1st and 5th minute), need for mechanical ventilation, duration of oxygen therapy, and surfactant re-dosing were collected using a structured checklist. Statistical analysis was performed using SPSS v26.

Mean gestational age was 30.9 ± 2.6 weeks. Short-term outcomes revealed no statistically significant difference in mortality between the two methods. However, the MIST group demonstrated significantly lower rates of short-term complications, including reduced duration of mechanical ventilation (P = 0.0001), retinopathy of prematurity (ROP; P = 0.026), and sepsis (P = 0.010).

MIST is a safe and effective alternative to INSURE for surfactant administration in preterm infants with RDS. It is associated with improved short-term outcomes, including shorter mechanical ventilation duration and lower incidences of ROP and sepsis. These findings support MIST as a preferable approach in clinical practice.