Can Laryngeal Mask Airway be used for surfactant administration in neonates?

Roberts and colleagues in a randomized clinical trial examined the feasibility of instilling surfactant non-invasively through and LMA in infnats > 1250g. They found out that surfactant administration by LMA significantly decreased the need for intubation and mechanical ventilation in the first 7 days of life. They reported no serious adverse events including emergent intubations or tension pneumothorax. Post-procedure gastric aspirates revealed 26% had no surfactant aspirated from the stomach, 46% had <10% of the administered dose and 18% had >50% of the administered dose, in the LMA group. Roberts KD, Brown R, Lampland AL, Leone TA, Rudser KD, Finer NN, et al. Laryngeal mask airway for surfactant administration in neonates: A randomized, controlled trial, J. Pediatr, 2018 Feb; 193; 40-6.