Feasibility of Surfactant Delivery via Preterm Supraglottic Airways in Infants with Birth Weights of 800-1500 g.

Abstract

To assess feasibility and safety of airway management and surfactant administration using newly developed preterm-sized supraglottic airways (SAs) in infants with respiratory distress syndrome and birth weight 750 -1500 g. This investigator-initiated, single-arm interventional feasibility study was conducted in a level III neonatal intensive care unit at Phu San Hanoi Hospital (35,000 annual births). Infants with birth weights 750-1500 g were enrolled after parental consent. Surfactant was administered via preterm-sized SAs. The primary outcome was successful placement within 2 attempts. Video recordings were used to assess procedure characteristics and physiologic stability by continuous pulse oximetry. Data were summarized descriptively and compared for infants with weights of <1000 vs 1000-1500 g. Forty-five infants (median birth weight: 1300 g; range: 800-1500 g) were enrolled. SA placement was successful in 98% of cases, with 82% on the first attempt. For 27% of cases, this was the provider's first SA use. The median time to successful airway placement was 21 seconds, and the entire procedure lasted a median of 5.4 minutes. Surfactant was delivered by SA in 93% of cases and the median FiO₂ decreased from 0.40 to 0.25 one hour post-procedure (P <0.001). Three desaturations (<60%) and one bradycardia (<60 beats per minute) occurred; no other procedure-related serious adverse events were reported. No differences in response or adverse events were found in infants with birth weight <1000g. Use of preterm sized SAs for surfactant delivery in infants weighing 800-1500 g was feasible and well tolerated. Large randomized controlled trials are needed to compare its efficacy and safety with conventional administration of surfactant.