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Comparative study of the effect of the administration of surfactant through a thin endotracheal catheter into trachea during spontaneous breathing with intubation (intubation-surfactant-extubation method)

Introduction: The main reason for respiratory distress syndrome (RDS) is surfactant deficiency. One of the methods for surfactant administration is through a thin endotracheal catheter (TEC) during the spontaneous breathing of an infant. To identify the clinical effects of this method, we decided to compare the effect of surfactant administration through a TEC during spontaneous breathing through the intubation-surfactant-extubation (INSURE) method. Methodology: In a single-blind clinical trial, we randomly divided 40 premature infants with a gestational age of <32 weeks and birth weight of <1500 g suffering from RDS who needed surfactant administration, into the two groups of intervention (TEC) and control (INSURE). The treatment results were compared in the two groups in terms of the frequency and duration of mechanical ventilation requirement, duration of nasal continuous positive airway pressure (NCPAP) requirement, duration of infants' stay in neonatal intensive care unit, and side effects such as pulmonary hemorrhage, frequency and severity of intraventricular hemorrhage of the brain, and also death at 28 days of age. Results: The infants of both groups did not significantly differ in terms of gender, mode of delivery, Apgar score at 1 and 5 min, gestational age, and birth weight (P > 0.05). The mechanical ventilation requirement in the infants of the control group was significantly higher compared to the intervention group (P = 0.027). The duration of NCPAP requirement and duration of hospitalization in the groups did not significantly differ (P > 0.05). Conclusion: Based on our results, the TEC method decreases mechanical ventilation requirement, but NCPAP requirement and duration of stay did not differ from the normal method, therefore, TEC can be an acceptable alternative to INSURE.