Surfactant Administration by Supraglottic Airway for Preterm Infants with Respiratory Distress Syndrome: The SURFSUP 1 Trial

Abstract

Respiratory distress syndrome (RDS) is a condition found commonly in babies born prematurely, which results in breathing difficulty soon after birth, due to immaturity of the lungs. Many babies will be managed successfully with breathing support alone, but some require additional treatment with surfactant. Surfactant is a liquid that is applied directly into the baby’s airway, which helps open the lungs to make breathing easier Currently, the standard method to administer surfactant requires laryngoscopy. This is where a doctor looks directly into the baby’s airway using a laryngoscope (a metal device that holds the airway open) and then inserts a tube into the airway to deliver the surfactant treatment. This method is very effective, but is challenging to learn, and may take more than one attempt even for experienced doctors. Also, during laryngoscopy, some babies may briefly have a drop in their heart rate or oxygen levels. ‘Supraglottic airways’ are a different type of device, made from a soft plastic, shaped to fit into the mouth and form a seal over the airway opening. They can be inserted without using a metal laryngoscope, and are easier to use for doctors and more comfortable for babies. Previous research suggests that surfactant treatment can be given through a supraglottic airway, but we do not yet know if this method is as effective as using direct laryngoscopy in helping the baby’s breathing. This research study will compare the new method, supraglottic airway surfactant treatment, with the current standard method, laryngoscopy. We will measure how stable babies are during surfactant treatment, including their oxygen levels and heart rate. We will also record how many babies need a higher level of breathing support (ventilation by a breathing tube), to determine how effective the treatment is in helping babies with RDS. If supraglottic airway surfactant treatment can be used safely and effectively, and is more comfortable and easy to use, it could become the preferred method of surfactant treatment for babies with RDS.