What is the principle of Less Invasive Surfactant Administration (LISA)?

• A. Administer surfactant via a thin catheter to a spontaneously breathing infant on CPAP, avoiding intubation.
• B. Intubate and deliver surfactant via conventional ventilation.
• C. Deliver surfactant via nebulization during deep sedation.
• D. Delay surfactant until full ventilatory support.

Answer: (A)

Less invasive surfactant administration delivers surfactant through a thin catheter placed into the trachea of a spontaneously breathing infant who is on CPAP, avoiding intubation and mechanical ventilation. The infant remains on noninvasive support while surfactant is given in small portions, typically with visualization of the airway and careful catheter advancement, then the catheter is removed and CPAP is continued. This approach treats surfactant deficiency early without the lung injury risks associated with endotracheal intubation and conventional ventilation, aiming to improve oxygenation and outcomes while preserving the infant’s own breathing efforts.

Other methods involve intubation and ventilation, which increases invasiveness and potential ventilation-associated lung injury; nebulization during deep sedation and delaying surfactant until full ventilatory support are not aligned with the principle of delivering surfactant while maintaining noninvasive support.