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Surfactant Administration by Transient Intubation in Infants 29 to 35 Weeks' Gestation with Respiratory Distress Syndrome Decreases the Likelihood of Later Mechanical Ventilation: A Randomized Controlled Trial



To assess, among premature infants with early respiratory distress syndrome (RDS), the effect of one dose of intratracheally administered surfactant followed by extubation to nasal continuous positive airway pressure (NCPAP) on subsequent mechanical ventilation (MV), when compared with NCPAP alone.


Randomized, blinded trial in infants 29 to 35 weeks' gestation with mild-to-moderate RDS requiring supplemental oxygen and NCPAP. Infants were randomized to intubation, surfactant treatment, and immediate extubation (surfactant group N=52), or to no intervention (control group N=53). All infants were subsequently managed with NCPAP.


Need for later MV was 70% in the control group and 50% in the surfactant group. Surfactant group subjects had lower inspired oxygen fraction (FiO2) after study intervention and were less likely to require subsequent surfactant. Overall surfactant use, duration of O2 therapy, length of stay, and bronchopulmonary dysplasia were unaffected.


Among premature infants with mild-to-moderate RDS, transient intubation for surfactant administration reduces later MV.

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We thank Lawrence Consenstein, Christopher Cox, Kristina Mossgraber and Cassandra Horihan for help in study design and analysis. We also thank the University of Rochester Neonatal Clinical Trials Group for their intellectual input, the neonatal physicians, nurses, and respiratory therapists for their work, and the subjects' parents for their generosity.

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This research was supported in part by the University of Rochester General Clinical Research Center (5 M01 RR00044). Abbott Laboratories provided the surfactant (Survanta®) used in the study.

Conflict of interest: None of the authors have any potential conflict of interest, real, or perceived.

Supplementary Information accompanies the paper on the Journal of Perinatology website (

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Reininger, A., Khalak, R., Kendig, J. et al. Surfactant Administration by Transient Intubation in Infants 29 to 35 Weeks' Gestation with Respiratory Distress Syndrome Decreases the Likelihood of Later Mechanical Ventilation: A Randomized Controlled Trial. J Perinatol 25, 703–708 (2005).

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