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Feasibility and safety of surfactant administration via laryngeal mask airway as first-line therapy for a select newborn population: results of a standardized clinical protocol

Journal of Perinatology volume 45, pages 36–42 (2025)Cite this article

Subjects

Abstract

Objectives

(1) To demonstrate feasibility and safety of surfactant administration via laryngeal mask airway (LMA) as a first-line therapy. (2) To measure treatment success, defined as avoidance of intubation/invasive mechanical ventilation, and determine if specific clinical variables could predict success/failure.

Study design

Observational cohort with eligible infants given surfactant using one type of LMA via standardized protocol. Data was captured prospectively followed by retrospective chart review.

Results

120 infants ≥1250 g and 28.3–41.1 weeks gestation were included. First-line LMA surfactant therapy was successful in 70% of the infants and those infants weaned to room air significantly quicker than infants requiring subsequent intubation/mechanical ventilation (p = 0.002 by 72 h, p = 0.001 by 96 h). Clinical variables assessed could not predict treatment success/failure. Complications were infrequent and did not differ between groups.

Conclusion

First-line LMA surfactant is feasible and safe for certain infants. Prediction of treatment success was not possible in our cohort.

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Fig. 1: Distribution of initial respiratory management and timing to wean to room air.

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Data availability

The datasets generated during and analyzed during the current study are not publicly available due to IRB restrictions but are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank South Shore Hospital NICU respiratory therapists and nurses for their support with clinical protocol.

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Authors and Affiliations

  1. Department of Pediatrics, South Shore Hospital, Weymouth, MA, USA

    Zuzanna Kubicka, Eyad Zahr, Tamara Rousseau, Theresa Welgs, Amy Ditzel, Diana Perry, Molly Lacy, Carolyn O’Rourke & Bonnie Arzuaga

  2. Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA, USA

    Zuzanna Kubicka, Eyad Zahr, Tamara Rousseau, Theresa Welgs, Amy Ditzel, Diana Perry, Molly Lacy & Bonnie Arzuaga

  3. Harvard Medical School, Boston, MA, USA

    Zuzanna Kubicka & Henry A. Feldman

  4. Institutional Centers for Clinical and Translational Studies, Boston Children’s Hospital, Boston, MA, USA

    Henry A. Feldman

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  1. Zuzanna Kubicka
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Contributions

ZK conceptualized and designed the study, designed the data collection instruments, coordinated and supervised data collection, collected data, drafted the initial manuscript, and reviewed and revised the manuscript. BA, TW, EZ, AD, DP, TR, and ML contributed to the study design, data collection, and reviewed and revised the manuscript. CR RRT-NPS contributed to study design, created data capture tool, contributed to data collection, and reviewed and revised the manuscript. HAF conceptualized and designed the study, carried out the initial and final statistical analyses, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Zuzanna Kubicka.

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The authors declare no competing interests.

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Supplementary information

41372_2024_2099_MOESM1_ESM.doc

“Guideline for Surfactant administration by LMA”, “LMA for Surfactant Administration Algorithm”, “LMA/Surfactant capture tool”

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Kubicka, Z., Zahr, E., Feldman, H.A. et al. Feasibility and safety of surfactant administration via laryngeal mask airway as first-line therapy for a select newborn population: results of a standardized clinical protocol. J Perinatol 45, 36–42 (2025). https://doi.org/10.1038/s41372-024-02099-8

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