Early Experience With Less Invasive Surfactant Administration Under Heated Humidified High-Flow Nasal Cannula in Preterm Infants: An Observational Pilot Study

Büyükeren M., Celik T., YİĞİT Ş., YURDAKÖK M.

Zeitschrift fur Geburtshilfe und Neonatologie, 2026 (SCI-Expanded, Scopus)

Özet

Background: Less invasive surfactant administration (LISA) is commonly performed under nasal continuous positive airway pressure (CPAP). Evidence regarding its use under heated humidified high-flow nasal cannula (HHHFNC) support is limited. Objective: To describe the feasibility of performing LISA under ongoing HHHFNC support and to explore short-term physiological observations compared with nasal CPAP in preterm infants. Methods: This observational pilot study was conducted in a tertiary neonatal intensive care unit between January and December 2017. Preterm infants with respiratory distress syndrome requiring surfactant therapy within the first 72 hours of life were included. Infants received non-invasive respiratory support with either nasal CPAP or HHHFNC. Vital signs, blood gas parameters, perfusion index (PI), and pleth variability index (PVI) were recorded before and at predefined time points after surfactant administration. Results: A total of 34 preterm infants was analyzed (CPAP: n=22; HHHFNC: n=12). No statistically significant differences were observed between groups in vital signs, blood gas parameters, PI, or PVI values at any time point. Oxygen saturation at 360 minutes was higher in the HHHFNC group (p=0.030). No major short-term physiological instability was observed during the monitoring period. Conclusions: This observational pilot study suggests that LISA can be technically performed under ongoing HHHFNC support in selected preterm infants. However, because of the observational design, small sample size, and baseline imbalances, no conclusions regarding comparative safety or efficacy relative to CPAP can be drawn.