Pilot Study to Evaluate a New Method for Endotracheal Administration of Surfactant in Neonatal Respiratory Distress Syndrome: Fiberscope Assisted Surfactant Therapy (FAST).

Introduction: Currently, INSURE (Intubation-Surfactant-Extubation) and LISA (Less Invasive Surfactant Administration) are two recommended techniques for surfactant delivery to newborns with respiratory distress syndrome. The aim of this study was to evaluate the feasibility, safety, tolerability of a new technique of surfactant administration in newborns without anesthesia or laryngoscopy: Fiberscope Assisted Surfactant Therapy (FAST).

Methods: This monocentric, prospective, nonrandomized, pilot feasibility study was conducted from January to December 2021. Spontaneously breathing infants born ≥28 weeks gestational age with respiratory distress syndrome received surfactant by a 1.5 French catheter inserted in the trachea using a flexible endoscope without anesthesia, while maintaining a continuous positive expiratory pressure. The learning curve of this new technique by caregivers was studied during training sessions on high fidelity mannequins.

Results: Eight infants born ≥28 weeks of gestation with a birth weight of 1,000 g-2,685 g were included in the study. FAST was successfully performed in each case without anesthesia, second dose of surfactant or mechanical ventilation. One hour after FAST, a decrease of FiO2 and PCO2 and an increase of arterial pressure and pH were recorded with medians of individual differences of -0.9, -4 mm Hg, 6.5 mm Hg, and 0.06, respectively. The learning curves of 13 physicians showed a rapid mastery of FAST from the third attempt onwards (mean duration of 113, 66, and 50 s for 1st, 2nd, and 3rd attempts, respectively, 29-37 s for further attempts).

Conclusion: FAST may be considered as a possible new minimally invasive surfactant therapy technique for neonates ≥28 weeks with mild respiratory distress syndrome.