Administration of surfactant using less invasive techniques as a part of a non-aggressive paradigm towards preterm infants.

Traditional treatment of respiratory distress syndrome in preterm infants consisted of early intubation, mechanical ventilation and intra-tracheal administration of exogenous surfactant. Recently, non-invasive ventilation, which has shown some advantages in short- and long-term outcomes, has gained popularity for the initial management of respiratory insufficiency in preterm infants. However, non-invasive ventilation from the outset poses difficulties in relation to administration of exogenous surfactant. The customary INSURE technique requires tracheal intubation, surfactant administration, and rapid extubation, but the latter is not always possible. As a more elegant approach, several minimally invasive techniques of delivering surfactant have been developed for babies spontaneously breathing on CPAP. The most extensively studied have been those in which the trachea is briefly catheterized with a nasogastric tube or vascular catheter, and exogenous surfactant is administered. Although results seem promising they are not yet conclusive, and further studies will be needed to answer a number of outstanding questions.