Respiratory distress syndrome (RDS) is common in very preterm infants due to surfactant deficiency. Surfactant replacement therapy is lifesaving, and current guidelines recommend the less invasive surfactant administration (LISA) technique. However, the optimal duration of surfactant instillation during LISA has never been systematically evaluated. Rapid instillation may provoke transient hypoxia and bradycardia, while slower administration might improve physiological stability and cerebral oxygenation.
This randomised controlled trial investigates whether the duration of surfactant administration (1 minute versus 5 minutes) affects cerebral and systemic oxygen stability in extremely preterm neonates (\< 28 weeks).
Preterm neonate <28+0 weeks (gestational age up to 27 weeks and 6 days)
Indication of surfactant administration via the LISA method
Postnatal age < 72 hours
Invasive ventilation, indication of INSURE procedure
Severe pulmonary or cardiac malformation affecting oxygenation or congenital cerebral malformation
Preexisiting diagnose of any IVH > grade 2 or PVH.