Fiberscope-Assisted Surfactant Therapy (FAST) in Neonatal Respiratory Distress Syndrome: Four-Year Retrospective...

Background/Objective: Surfactant replacement therapy remains a life-saving intervention in the management of neonatal respiratory distress syndrome (RDS). In 2022, we presented a novel minimally invasive method of surfactant delivery with a flexible endoscope: Fiberscope-Assisted Surfactant Therapy (FAST). This new study describes the clinical course of neonatal RDS in neonates treated with FAST, comparing them to those treated with INSURE (Intubation-Surfactant-Extubation). Method: In this single-center cohort study, we retrospectively analyzed data from neonates with RDS admitted to our unit between 2021 and 2024. Following surfactant therapy, short- and medium-term respiratory and hemodynamic effects were compared between the two cohorts. Results: Data from 21 neonates born at 27 to 35 weeks of gestation (birth weights 890-2685 g) treated with FAST and 37 neonates born at 27 to 35 weeks (birth weights 920-2910 g) treated with INSURE were analyzed. The two groups were comparable in gestational age and antenatal steroid exposure. In the FAST group, the procedure was successfully completed in all cases without sedation and analgesia, with a consistent trend toward reduced FiO₂ and pCO₂, as well as increased pH. Comparing FAST with INSURE, no significant differences were observed in respiratory outcomes, with a significant difference in the need for blood volume expansion after surfactant delivery (1 infant in FAST vs. 17 infants in INSURE; p < 0.001). Conclusions: FAST demonstrated comparable respiratory efficacy to INSURE, with greater hemodynamic stability without sedation and analgesia or laryngoscopy, making it an even less invasive option for surfactant therapy.