A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates [Ensaio controlado randomizado de máscara laríngea para administração de surfactantes em neonatos]

Objective to compare the short-term efficacy of surfactant administration by laryngeal mask airway versus endotracheal tube. methods preterm infants (28–35 weeks of gestational age),weighing 1 kg or more,with respiratory distress syndrome,requiring nasal continuous positive airway pressure,with increased respiratory effort and/or fraction of inspired oxygen (fio2) ≥ 0.40 to maintain oxygen saturation 91–95%,were randomized to receive surfactant by lma following ncpap or by ett following mechanical ventilation (mv). the primary outcome was a clinical response defined as fio2 ≤ 0.30 three hours after surfactant. secondary outcomes for lma group were: need of surfactant retreatment during the first 24 h,mv requirement,and presence of surfactant in gastric content. results forty-eight patients were randomized; 26 in the lma group and 22 in the ett group. six of 26 patients (23%) in the lma group and five of 22 patients (22.7%) in the ett group did not meet the primary outcome (p = 0.977). fourteen (53.8%) of the lma patients were not intubated nor ventilated; 12 (46.1%) were ventilated: for surfactant failure (23%),for ncpap failure (11.5%),and for late complications (11.5%). groups were similar regarding prenatal status,birth conditions,and adverse events. no significant gastric content was found in 61.5% of the lma patients. oxygen and second dose surfactant requirements,arterial/alveolar ratio,and morbidities were similar among groups. conclusions surfactant administration by lma showed short-term efficacy,with similar supplementary oxygen need compared to surfactant by ett,and lower mv requirement. further studies with larger sample size are necessary to confirm these results. © 2017 sociedade brasileira de pediatria