Less-Invasive Surfactant Administration for Neonatal Respiratory Distress Syndrome: A Consensus Guideline

Neonatology. 2021;118(5):586-592. doi: 10.1159/000518396. Epub 2021 Sep 2.


Introduction: Less-invasive surfactant administration (LISA) is a method of surfactant delivery to preterm infants for treating respiratory distress syndrome (RDS), which can reduce the composite risk of death or bronchopulmonary dysplasia and the time on mechanical ventilation.

Methods: A systematic literature search of studies published up to April 2021 on minimally invasive catheter surfactant delivery in preterm infants with RDS was conducted. Based on these studies, with parental feedback sought via an online questionnaire, 9 UK-based specialists in neonatal respiratory disease developed their consensus for implementing LISA. Recommendations were developed following a modified, iterative Delphi process using a questionnaire employing a 9-point Likert scale and an a priori level of agreement/disagreement.

Results: Successful implementation of LISA can be achieved by training the multidisciplinary team and following locally agreed guidance. From the time of the decision to administer surfactant, LISA should take <30 min. The comfort of the baby and requirements to maintain non-invasive respiratory support are important. While many infants can be managed without requiring additional sedation/analgesia, fentanyl along with atropine may be considered. Parents should be provided with sufficient information about medication side effects and involved in treatment discussions.

Conclusion: LISA has the potential to improve outcomes for preterm infants with RDS and can be introduced as a safe and effective part of UK-based neonatal care with appropriate training.

Keywords: Neonate; Respiratory distress syndrome; Surfactant administration.

MeSH terms

  • Bronchopulmonary Dysplasia* / drug therapy
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Practice Guidelines as Topic
  • Pulmonary Surfactants* / therapeutic use
  • Respiratory Distress Syndrome, Newborn* / drug therapy
  • Surface-Active Agents


  • Pulmonary Surfactants
  • Surface-Active Agents