Preterm infants commonly develop respiratory distress syndrome (RDS) requiring some form of respiratory support and potentially surfactant administration (1). Treatment with surfactant has been shown to reduce the risk of death and bronchopulmonary dysplasia (BPD) in preterm infants; however, the standard approach to administering surfactant involves using an endo-tracheal tube and a period of mechanical ventilation (MV). It is well known that MV causes damage to the fragile preterm lungs (2) so many lung protective strategies for respiratory management and ventilation have been developed.
As per our current guideline on the respiratory management of preterm infants the preferred initial management is using primary CPAP with the use of rescue surfactant for infants with an increasing oxygen requirement. To reduce the need for MV but still deliver surfactant several less invasive techniques have been developed.
The successful use of the laryngeal mask to deliver surfactant in preterm infants with RDS has been described in randomised controlled trials since 2013 (3)(4)(5). More recently Roberts et al described a significant reduction in the requirement for mechanical ventilation in preterm infants with moderate RDS who received surfactant by LMA compared with infants maintained on primary CPAP (6).