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Supraglottic airway devices for administration of surfactant to newborn infants with respiratory distress syndrome: a narrative review
  1. Calum T Roberts1,2,3,
  2. Brett James Manley4,5,6,
  3. Joyce E O'Shea7,
  4. Michael Stark8,9,
  5. Chad Andersen8,9,
  6. Peter G Davis4,
  7. Adam Buckmaster10,11
  1. 1Department of Paediatrics, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
  2. 2Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia
  3. 3The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
  4. 4Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia
  5. 5Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  6. 6Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
  7. 7Department of Paediatrics, Royal Hospital for Sick Children, Glasgow, Scotland, United Kingdom
  8. 8The Robinson Institute, University of Adelaide, Adelaide, South Australia, Australia
  9. 9Department of Neonatal Medicine, Women's and Children's Hsopital, Adelaide, South Australia, Australia
  10. 10Women, Children and Families, Central Coast Local Health District, Gosford, New South Wales, Australia
  11. 11School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
  1. Correspondence to Dr Calum T Roberts, Dept. of Paediatrics, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, VIC 3168, Australia; calum.roberts{at}


Surfactant is an effective treatment for respiratory distress syndrome, being particularly important for infants in whom continuous positive airway pressure (CPAP) provides insufficient support. Supraglottic airway devices present an attractive option for surfactant delivery, particularly as an alternative to methods dependent on direct laryngoscopy, a procedural skill that is both difficult to learn and in which to maintain competence. Published studies provide encouraging data that surfactant administration by supraglottic airway device can be performed with a high rate of success and may reduce the need for subsequent intubation compared with either continued CPAP or surfactant administration via endotracheal tube. However, existing randomised controlled trials (RCTs) are heterogeneous in design and include just over 350 infants in total. To date, all RCT evidence has been generated in tertiary units, whereas the greatest potential for benefit from the use of these devices is likely to be in non-tertiary settings. Future research should investigate choice and utility of device in addition to safety and effectiveness of procedure. Importantly, studies conducted in non-tertiary settings should evaluate feasibility, meaningful clinical outcomes and the impact that this approach might have on infants and their families. Supraglottic airway devices may represent a simple and effective mode of surfactant administration that can be widely used by a variety of clinicians. However, further well-designed RCTs are required to determine their role, safety and effectiveness in both tertiary and non-tertiary settings before introduction into routine clinical practice.

  • neonatology
  • therapeutics

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  • Contributors CTR wrote the first draft of the manuscript. All authors revised the manuscript content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing not applicable as no datasets were generated and/or analysed for this study. N/A.

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