Effectiveness of Surfactant Administration in Two Different Methods (MIST, INSURE) on the Short-Term Outcome of Preterm Infants With Respiratory Distress Syndrome: A Randomized Clinical Trial
In brief
MIST infants avoided repeat surfactant and ventilation; 10% on INSURE needed each
In this randomized trial of 80 preterm infants, none receiving minimally invasive surfactant therapy (MIST) needed a second dose or mechanical ventilation, compared with 10.3% in the INSURE group. These differences were not statistically significant, and breathing support duration was similar; larger trials are needed to determine whether MIST offers a real clinical advantage.
- Journal
- Pediatric pulmonology (Q1)
- Published
- 1 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Fatemeh Heidarzadeh, Samira Pournajaf, Zahra Akbarian-Rad, Nesae Bozorgnezhad, Hemmat Gholinia Ahangar, Mohsen Haghshenas
- PMID
- 42876349
- DOI
- 10.1002/ppul.71874
Why clinicians should know about it
- Picked for Neonatology (paper of the day, 16 October 2026): MIST vs INSURE surfactant; fewer pneumothorax, re‑dose, ventilation
Abstract
INTRODUCTION: Preterm birth (< 37 weeks) causes high neonatal mortality, with respiratory distress syndrome (RDS) as a major complication due to surfactant deficiency. Surfactant administered via several methods. This study compares effectiveness and complications of two different methods of surfactant therapy. METHODS: This randomized clinical trial was conducted involving two groups of a total of 80 neonates aged 28-34 weeks who, based on clinical conditions, required surfactant administration. In the INSURE method, the infant is first intubated with an appropriate size endotracheal tube, subsequently, surfactant is administered in a controlled manner using a feeding catheter and 20 cmH2O positive pressure ventilation (PPV) and 5 cmH2O positive end expiratory pressure (PEEP) with a T-piece device, and in the MIST method, while the infant is on nasal CPAP with a PEEP of 5 cmH2O, a thin feeding catheter is inserted into the trachea and Surfactant is then slowly administered at the same dose, the catheter is immediately removed and nasal CPAP is continued. And the outcomes included the duration of respiratory support, need for surfactant re-administration, mechanical ventilation and complications such as pulmonary hemorrhage, pneumothorax evaluated. RESULTS: indicated that none of the infants in the MIST group developed pneumothorax, required a second dose of surfactant, or underwent mechanical ventilation, compared with 12.8% (p = 0.055), 10.3% (p = 0.123), and 10.3% (p = 0.123), respectively, in the INSURE group. similarly, the duration of CPAP support and oxygen therapy did not differ significantly between the groups. CONCLUSIONS: Although many of the findings did not reach statistical significance, MIST appears to be associated with potentially important clinical benefits that should not be overlooked. Further studies with larger sample sizes are warranted to confirm these findings.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.