A 30-week preterm neonate (1.2 kg) develops worsening respiratory distress, grunting, and requires increasing oxygen support in the first 6 hours of life. CXR shows diffuse ground-glass opacity with air bronchograms and reduced lung volumes. Surfactant is administered. Which surfactant preparation and route of administration constitutes the LESS INVASIVE SURFACTANT ADMINISTRATION (LISA) technique?

• A Calfactant delivered via a thin catheter (Angiocath/NG tube) passed through the vocal cords into the trachea while the infant breathes spontaneously on nCPAP ✓
• B Poractant alfa instilled via endotracheal tube during brief intubation, then immediate extubation
• C Beractant administered via nebulization during nCPAP support
• D Surfactant instilled into the pharynx for swallowing and absorption

Explanation

The LISA (Less Invasive Surfactant Administration) technique — also called MIST (Minimally Invasive Surfactant Therapy) — involves passing a thin catheter (vascular catheter, feeding tube, or dedicated device) through the vocal cords into the trachea under direct laryngoscopy while the infant remains on nCPAP, breathing spontaneously, without endotracheal intubation or positive pressure ventilation. This preserves spontaneous breathing and avoids the lung injury of mechanical ventilation. Poractant alfa (Curosurf) or beractant can be used. Nebulization delivers insufficient surfactant to the distal airways and is not standard practice. Pharyngeal instillation is an experimental method.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.