Assess impact of Nebulized surfactant to lessen respiratory distress severity

Abstract

Background: Neonatal respiratory distress syndrome (RDS) is commonly managed with non-invasive nasal continuous positive airway pressure (nCPAP). However, some infants experience nCPAP failure, necessitating intubation and surfactant administration. While bolus surfactant delivery is effective, it carries risks. Nebulised surfactant offers a non-invasive alternative, but its efficacy in reducing nCPAP failure in preterm neonates remains unclear.
Methods: This trial evaluated the safety and effectiveness of nebulised surfactant for preterm neonates (290–336 weeks gestational age) with mild-to-moderate RDS on nCPAP. Eligible neonates were randomized within 4 hours of birth to receive nebulised surfactant (200 mg/kg poractant alfa) or sham nebulisation. Primary outcomes included the need for intubation within 72 hours and mean duration of mechanical ventilation. Secondary outcomes included neonatal morbidities and physiological stability. Data analysis followed an intention-to-treat approach.
Results: Of 64 enrolled infants, the nebulised surfactant group had a significantly lower intubation rate within 72 hours compared to controls (RR = 0.526, 95% CI 0.292–0.950). The reduction was most pronounced in infants aged 320–336 weeks’ gestation. The median duration of mechanical ventilation did not differ significantly between groups. Safety analysis revealed no severe adverse effects, with transient hypercapnia during nebulisation resolving immediately. Neonatal complications were comparable between groups.
Conclusion: Nebulised surfactant reduces nCPAP failure rates in preterm infants with mild RDS, particularly in older gestational subgroups, without increasing adverse outcomes. Larger trials are necessary to confirm these findings and explore alternative delivery methods and interfaces.