Am J Perinatol 2018; 35(06): 530-533
DOI: 10.1055/s-0038-1637759
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Is Less Invasive Surfactant Administration Necessary or “Only” Helpful or Just a Fashion?

Gianluca Lista
1  Division of Neonatology, “V.Buzzi” Children's Hospital, Asst Fatebenefratelli Sacco, Milan, Italy
Ilia Bresesti
1  Division of Neonatology, “V.Buzzi” Children's Hospital, Asst Fatebenefratelli Sacco, Milan, Italy
Laura Fabbri
2  Global Clinical Development-Neonatology, Chiesi Farmaceutici S.p.A, Parma, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
25 April 2018 (online)


In the 1990s, the most relevant pillars in the treatment of neonatal respiratory distress syndrome (RDS) have been improvements in ventilation strategies, the introduction of exogenous surfactant replacement therapy, and the use of antenatal steroids. Lately, in addition to the standard INSURE (INtubation–SURfactant administration–Extubation) method to administer surfactant, a new technique has been gaining increasing popularity. It is the so-called less invasive surfactant administration (LISA) method, which has shown promising results in preventing bronchopulmonary dysplasia development and in reducing mortality in preterm neonates. The rationale behind this technique is to avoid positive pressure ventilation and the endotracheal tube, being surfactant delivered through a thin catheter while the neonate is maintained on continuous positive airway pressure. Given the paucity of large-scale randomized trials on LISA method to prove its effects on short- and long-term outcomes, some questions still remain unanswered. Then, uncertainty regarding the feasibility of this maneuver needs to be better clarified before gaining wide acceptance in routine clinical practice. In our report, we aim at hypothesizing the main mechanisms behind the efficacy of LISA, considering it as a single maneuver in a comprehensive approach for RDS management in the delivery room.