Nebulized surfactant in preterm neonates ≤34 weeks of gestation with respiratory distress syndrome: a pilot study

Respiratory distress syndrome (RDS) is a leading cause of morbidity and mortality in preterm neonates. Aerosolized (nebulized) surfactant offers a non-invasive safe alternative. However, its safety, feasibility, and clinical effectiveness in low-resource settings remain under-investigated. Fifteen inborn preterm neonates ≥ 28 weeks of gestation with RDS requiring FiO2 >30% on NIPPV were administered Neosurf surfactant via aerogen vibrating mesh nebulizer. Each enrolled neonate was matched to three historical controls (n = 45) who received surfactant via INSURE. The primary outcome was the need for repeat surfactant dosing within 72 hours. Repeat surfactant dosing was required in 13.3% (2/15) of the nebulized group vs. 11.1% (5/45) of controls (p = 0.08). Nebulized surfactant delivery using a vibrating mesh nebulizer is safe, well tolerated, and feasible in preterm neonates ≥28 weeks gestation with RDS on non-invasive ventilation. Larger randomized controlled trials are warranted to confirm efficacy and optimize delivery strategies.