Less invasive surfactant administration (LISA) - ways to deliver surfactant in spontaneously breathing infants

The idea to deliver surfactant to spontaneously breathing premature infants is not new. The spectrum of methods reported reaches from aerosol administration over pharyngeal deposition, the use of laryngeal masks, short term intubation, surfactant administration and rapid extubation (INSURE) to an approach of keeping premature neonates on spontaneous breathing with continuous positive airway pressure support and administering surfactant by laryngoscopy via a small diameter tube. This way of Less Invasive Surfactant Administration (LISA) is in increasing use in the last decade in Germany. More than 1000 babies have been included in clinical studies on LISA by now. A first prospective randomized controlled trial (AMV-trial) demonstrated a significant reduction in the use of mechanical ventilation in LISA patients compared to standard treatment with intratracheal bolus administration of surfactant. Another recent study (Take Care study) indicates, that LISA may even be superior to INSURE. The search for even more "gentle" methods (e.g. nebulization) to deliver surfactant continues.