Pharyngeal instillation of surfactant before the first breath for prevention of morbidity and mortality in preterm infants at risk of respiratory distress syndrome

There is no current evidence from clinical trials to guide the use of pharyngeal instillation of surfactant before the first breath in preterm infants at risk of respiratory distress syndrome.

Respiratory distress syndrome is caused by a deficiency of natural lung detergent (surfactant) and occurs mainly in infants born before term (37 weeks' gestation). The usual treatment includes instilling artificial surfactant directly into the newborn infant's airway followed by mechanical ventilation. However, this process can lead to lung injury which may affect the infant's long-term health. A potential alternative strategy is to instil surfactant into the posterior pharynx as soon as the baby’s head appears, just before delivery of the shoulders. Thereafter, resuscitation measures are instituted as usual. This procedure has the potential to reduce the need to support the infant's breathing after birth, as well as any lung damage caused by mechanical ventilation. We did not find any trials for this review of pharyngeal instillation of surfactant before the first breath in preterm infants at risk of respiratory distress syndrome. In view of the encouraging results from animal studies and preliminary human studies, trials of pharyngeal instillation of surfactant before the first breath in preterm infants at risk of respiratory distress syndrome are needed.