# Laryngeal Mask Airway Method for Minimally Invasive Surfactant Therapy in Neonates with Pneumothorax Complicating Respiratory Distress Syndrome

## TL;DR

This paper presents a new method using a laryngeal mask airway to deliver surfactant to neonates with pneumothorax, avoiding the need for invasive ventilation and chest tubes.

## Contribution

The novel use of a laryngeal mask airway for surfactant therapy in neonates with pneumothorax is introduced.

## Key findings

- 13 out of 20 neonates avoided invasive ventilation and chest tube insertion using the laryngeal mask method.
- No major complications or unfavorable outcomes were observed in the cohort.
- The method is suggested as a preferred approach for surfactant delivery in neonates with pneumothorax.

## Abstract

Background/Objectives: Pneumothorax is a common complication of neonatal respiratory distress syndrome, which is decreased by surfactant therapy. Rescue administration of surfactant in neonates with severe RDS complicated by pneumothorax requires management of the pneumothorax to optimize surfactant distribution while avoiding positive pressure ventilation to minimize iatrogenic exacerbation of the air leak. Methods: We retrospectively reviewed our center’s experience with neonates who had clinically significant pneumothorax complicating RDS, in whom we used a novel technique to administer surfactant through a laryngeal mask/supraglottic airway device without applying positive pressure ventilation. Results: In 13 of the 20 neonates in our cohort, subsequent invasive ventilation and chest tube insertion were avoided. There were no major complications or unfavorable outcomes. We describe our experience with this method and suggest an approach to individualize the management of neonates with pneumothorax preceding surfactant therapy. Conclusions: In our setting, laryngeal mask airway devices are now the preferred method to deliver surfactant in neonates with RDS and pre-existing pneumothorax. We believe this approach is readily applicable in most neonatal care settings.