Alternative Methods of Surfactant Administration in Preterm Infants with Respiratory Distress Syndrome: State of the Art

Ömer Erdeve, Emel Okulu, Kari D. Roberts, Scott O. Guthrie, Prem Fort, H. Gözde Kanmaz Kutman, Peter A. Dargaville

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


For preterm infants with respiratory distress syndrome, delivery of surfactant via brief intubation (INtubate, SURfactant, Extubate; InSurE) has been the standard technique of surfactant administration. However, this method requires intubation and positive pressure ventilation. It is thought that even the short exposure to positive pressure inflations may be enough to initiate the cascade of events that lead to lung injury in the smallest neonates. In an effort to avoid tracheal intubation and positive pressure ventilation, several alternative and less invasive techniques of exogenous surfactant administration have been developed over the years. These have been investigated in clinical studies, including randomized clinical trials, and have demonstrated advantages such as a decrease in the need for mechanical ventilation and incidence of bronchopulmonary dysplasia. These newer techniques of surfactant delivery also have the benefit of being easier to perform. Surfactant delivery via pharyngeal instillation, laryngeal mask, aerosolization, and placement of a thin catheter are being actively pursued in research. We present a contemporary review of surfactant administration for respiratory distress syndrome via these alternative methods in the hope of guiding physicians in their choices for surfactant application in the neonatal intensive care unit.

Original languageEnglish (US)
Pages (from-to)553-562
Number of pages10
JournalTurkish Archives of Pediatrics
Issue number6
StatePublished - 2021

Bibliographical note

Publisher Copyright:
© 2021, AVES. All rights reserved.


  • Aerosol
  • Laryngeal mask
  • Less invasive surfactant administration
  • Nebulized
  • Pharyngeal instillation
  • Preterm
  • Respiratory distress syndrome
  • Surfactant


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