Low invasive surfactant administration by videolaringoscopy: a feasibility study

Background: Less invasive surfactant administration (LISA) is a gentle emerging technique for surfactant administration through a thin catheter in infants receiving noninvasive ventilation. It seems to offer some advantages to very preterm infants. The purpose of the FRee of Invasiveness & Neonatal Delicate LISA (FRI&NDLI) study was to evaluate the feasibility and safety of using videolaryngoscopy for positioning the thin catheter tip beyond the vocal cords. Methods: We studied preterm infants with 24+ 0-32+ 6 weeks of gestation, born between September 2020 and January 2024. Data of infants with mild/moderate respiratory distress syndrome (RDS) who received surfactant through the FRI&NDLI procedure were recorded. Frequency of successes and incidence of related adverse effects of the procedure were also recorded. Results: Twenty-three infants with 28.9 ± 2.8 weeks of gestational age and a birth weight of 1255 ± 458 g who received 25 procedures were studied. No episodes of apnoea, bradycardia, or desaturation were recorded during the glottis visualization in videolaryngoscopy. Two episodes of bradycardia, 8 episodes of desaturation, and 1 episode of surfactant reflux were observed during surfactant administration. Conclusion: We found that the FRI&NDLI procedure was safe and associated with less adverse effects than previously reported for LISA procedure using direct laringoscopy. Our findings support the possibility of planning further studies to compare the effectiveness of FRI&NDLI and LISA procedure for surfactant administration in preterm infants.