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Feasibility Study of Placement and Surfactant Administration Through a Preterm Size Laryngeal Mask Airway in Very Low Birth Weight Neonates With Respiratory Distress Syndrome

A Single-arm, Prospective Feasibility Study of Placement and Surfactant Administration Through a Preterm Size Laryngeal Mask Airway in Very Low Birth Weight Neonates, With Respiratory Distress Syndrome, at a Level III Neonatal Intensive Care Unit in Hanoi, Vietnam

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT06606444
Enrollment
45
Registered
2024-09-23
Start date
2024-09-20
Completion date
2025-08-01
Last updated
2025-08-19

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Respiratory Distress Syndrome, Newborn

Keywords

surfactant, laryngeal mask airway, supraglottic airway device, preterm infant, neonate, newborn, vietnam, feasibility, pilot, SALSA, RDS, respiratory distress syndrome, very low birth weight

Brief summary

Surfactant administration via a supraglottic airway device or laryngeal mask airway (SALSA) is a minimally invasive method of instilling surfactant in the trachea during spontaneous breathing and after applying nasal continuous positive airway pressure (nCPAP). However, the procedure has been limited from use in very low birth weight neonates, due to lack of preterm size LMAs, which are now emerging on the market. The goal of this study is to see if investigators can successfully use a new, smaller laryngeal mask airway (LMA) to place and give surfactant to premature babies with respiratory distress syndrome (RDS) who weigh between 750g and 1500g at birth. The main objectives of the study are to: * Check the placement of the new, smaller LMA: This includes evaluating the airway, how long it takes to place the LMA, how many attempts are needed, and the baby's stability during the process. * Evaluate the administration of surfactant using the new LMA: Investigators will look at how the baby responds clinically, any changes in oxygen needs, how many doses of surfactant are required, the level of respiratory support needed, and whether intubation or mechanical ventilation is necessary. * Ensure the safety of using the new LMA and administering surfactant: Investigators will monitor the baby's stability during the procedure and watch for any adverse events. * Assess pain during the procedure: Investigators will evaluate pain levels using a pain scale based on video reviews. Above objectives of feasibility are to be assessed before proceeding to a large randomize clinical trial assessing effectiveness and safety.

Detailed description

Methodology Feasibility will be measure by a combination of real-life observations of the procedure and video-review with synced physiological data (oxygen saturation and heart rate). Study Site The Phu San Hanoi Hospital, the largest obstetric hospital in northern Vietnam, receives about 40.000 births annually and has a level-III neonatal intensive care unit with capacity of approximately 40 neonates. Approximately 10-15 neonates weighing less than 1500g per month are admitted who receives standard surfactant treatment with IN-tubation-SURfactant-Extubation (INSURE).

Interventions

DEVICESurfactant Administration Through Laryngeal or Supraglottic Airways

While the child is spontaneously breathing on nasal CPAP treatment, the neonatal intensive care (NICU) physician will place the LMA and assess for adequate airway by CO2-detection, chest movement, pulmonary auscultation of bilateral breath sounds, gastric insufflation, oxygen saturation and heart rate. A placement attempt should not last more than 30 seconds. Surfactant will be administered slowly in 1-2 ml aliquots (Curosurf 200 mg/kg) via an appropriate size laryngeal mask airway. The neonate should primarily be spontaneously breathing and if needed receives gentle supportive positive pressure ventilation (PPV). Gentle supportive PPV is given for 30 seconds after surfactant is administered, before LMA is removed.

Sponsors

Hanoi Medical University
CollaboratorOTHER
Hanoi Obstetrics and Gynecology Hospital
CollaboratorOTHER
Göteborg University
CollaboratorOTHER
Karolinska Institutet
Lead SponsorOTHER

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
No minimum to 48 Hours
Healthy volunteers
No

Inclusion criteria

* Parental informed consent, AND * Inborn neonate (=born in the hospital), AND * Gestational age less than 34 + 0 weeks, AND * Age less than 48 hours, AND * Birth weight from 750g to 1500g, AND * Clinical diagnosis of RDS requiring non-invasive respiratory support (CPAP/NIPPV) and fraction of inspired oxygen (FiO2) 0.30-0.60 to maintain oxygen saturation (SpO2) between 90% and 95%.

Exclusion criteria

* Severe respiratory insufficiency in need of emergency intubation * Previous surfactant administration * Previous mechanical ventilation * Known pneumothorax * Major malformations * Investigators not available

Design outcomes

Primary

MeasureTime frameDescription
Successful LMA placement, with signs of adequate airway, allowing two attempts.During procedure. 0-30 minutes.Categorical variable (Yes/No) A successful placement attempt is defined as insertion of the LMA into the infant's mouth with signs of adequate airway, as per judgement of the physician performing the procedure. Factors that will be considered are carbon dioxide (CO2)-detection, chest movement, pulmonary auscultation of bilateral breath sounds, oxygen saturation and heart rate.

Secondary

MeasureTime frameDescription
Number of bradycardia less than 60 bpm for more than 10 secondsDuring procedure. 0-30 minutes.Numerical variable.
Number of surfactant doses givenWithin 7 days after birthNumerical variable
Need for subsequent intubation and mechanical ventilationWithin 7 days after birthCategorical variable (Yes/No)
Administration method for subsequent surfactant dosesWithin 7 days after birthCategorical. (Surfactant via laryngeal mask airway OR Surfactant via Intubation-Surfactant-Extubation OR Surfactant via intubation followed by mechanical ventilation)
Time between attemptsDuring procedure. 0-30 minutes.Numerical variable (seconds)
Confirmation of carbon dioxide on carbon dioxide detectorDuring procedure. 0-30 minutes.Categorical (Yes/No)
Chest rise during LMA placementDuring procedure 0-30 minutes.Categorical (Yes/No)
Bilateral breath sounds by auscultation during LMA placementDuring procedure. 0-30 minutes.Categorical (Yes/No)
Number of attempts required for successful placementDuring procedure. 0-30 minutes.Numerical variable.
Attempt duration more than 30 secondsDuring procedure. 0-30 minutes.Categorical variable (Yes/No)
Duration of each LMA placement attemptDuring procedure. 0-30 minutes.Numerical variable (seconds)
Fluctuations in heart rate during placementDuring procedure. 0-30 minutes.Numerical variable (beats per minute). Difference between mean/median at baseline and during placement. Measured by pulse oximetry.
Fluctuations in oxygen saturation (SpO2) during placementDuring procedure. 0-30 minutes.Numerical variable (percentage). Difference between mean/median at baseline and during placement. Measured by pulse oximetry.
Fluctuations in heart rate during surfactant administrationDuring procedure. 0-30 minutes.Numerical variable (beats per minute). Difference between mean/median at baseline and during surfactant administration. Measured by pulse oximetry.
Fluctuations in oxygen saturation (SpO2) during surfactant administrationDuring procedure. 0-30 minutes.Numerical variable (percentage). Difference between mean/median at baseline and during surfactant administration Measured by pulse oximetry.
Duration of SpO2 less than 80%During procedure. 0-30 minutes.Numerical variable (seconds)
Duration of SpO2 less than 60%During procedure. 0-30 minutes.Numerical variable (seconds)
Duration of SpO2 less than 40%During procedure. 0-30 minutes.Numerical variable (seconds)
Duration of heart rate less than 100 beats per minute (bpm)During procedure. 0-30 minutes.Numerical variable (seconds)
Duration of heart rate less than 60 beats per minute (bpm)During procedure. 0-30 minutes.Numerical variable (seconds)
Number of desaturations to less 80% for more than 30 secondsDuring procedure. 0-30 minutes.Numerical variable.
Number of apneas lasting more than 20 secondsDuring procedure. 0-30 minutes.Numerical variable
Volume of surfactant in gastric residuals after the procedureDuring procedure. 0-30 minutes.Numerical variable (milliliters)
Total procedure durationDuring procedure. 0-30 minutes.Numerical variable (seconds)
Duration of positive pressure ventilation during LMA placementDuring procedure. 0-30 minutes.Numerical variable (seconds)
Duration of positive pressure ventilation during surfactant administrationDuring procedure. 0-30 minutes.Numerical variable (seconds)
Duration of positive pressure ventilation during procedureDuring procedure. 0-30 minutes.Numerical variable (seconds)
Fraction of inspired oxygen10 minutes before procedure until 1 hour after procedure.Oxygen requirement to maintain SpO2 between 90-95%. Measured before start of procedure and at 5 minutes , 15 minutes , 30 minutes and 1 hour post-procedure.
Need for early redosing of surfactantWithin 6 hours from first surfactant administrationCategorical (Yes/No)
Need for invasive mechanical ventilation within 72 hoursWithin 72 hours after surfactant administrationCategorical (Yes/No)
DeathWithin 7 days after birthCategorical (Yes/No)
Duration of oxygen requirement after surfactant administrationWithin 7 days after birthNumerical (hours)
Duration of continuous positive airway pressure (CPAP) after surfactant administrationWithin 7 days after birthNumerical variable (hours)
Duration of non-invasive positive pressure ventilation (NIPPV) after surfactant administrationWithin 7 days after birthNumerical variable (hours)
Duration of invasive mechanical ventilation after surfactant administrationWithin 7 days after birthNumerical variable (hours)

Other

MeasureTime frameDescription
Neonatal pain scale: The Premature Infant Pain Profile-Revised (PIPP-R)Before, during and after procedure. 0-30 minutes.Assessed by video review of expert in neonatal pain assessment. Numerical variable. Indicators assessed in score: Change in heart rate from baseline (0-3p). Change in desaturation from baseline (0-3p). Brow bulge (seconds, 0-3p), Eye squeeze (seconds, 0-3p) nasolabial furrow (seconds, 0-3p), gestational age (0-3), Baseline behavioral state (0-3p. Minimum score is 0p and maximum score is 21p. Higher score indicates more pain.
Feasibility of obtaining neonatal pain score during and after procedure.During procedure. 0-30 minutes.Assessed by video review of expert in neonatal pain assessment
Quality of assessment of variables in pain scoreDuring procedure. 0-30 minutes.Assessed by video review by expert in neonatal pain assessment (eg. facial expressions, crying, breathing, pattern, leg and arm movements, and behavioral state)

Countries

Vietnam

Outcome results

None listed

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026