Abstract: Objective To compare the non-Magill forceps-assisted less invasive pulmonary surfactant (PS) administration (LISA) technique and the intubation surfactant and extubation (InSurE) technique. Methods The clinical data of 172 preterm infants (< 32 weeks of gestational age) with neonatal respiratory distress syndrome (NRDS) treated with PS were retrospectively analyzed. In the LISA group (n= 106 ), PS was injected with non-Magill forceps-assisted LISA technique, while in the InSurE group (n= 66 ), PS was injected with InSurE technique. The clinical characteristics of the two groups were compared and the effects of the two methods on prognosis were analyzed. Results In the LISA group, gestational age was smaller, body weight was lower, proportion of male and usage of poractant alfa were more than those in the InSurE group. The differences were statistically significant (P< 0 . 05 ). After the propensity score matching (PSM), a total of 43 pairs of cases were successfully matched, there was no significant difference between the two groups in baseline data (P> 0 . 05 ). There were no significant differences between the two groups after PSM in the main outcomes (mortality and incidence of bronchopulmonary dysplasia) and secondary outcomes (oxygen consumption time, noninvasive ventilation time, mechanical ventilation time, mechanical ventilation rate within 72 hours after birth, mechanical ventilation rate 72 hours after birth and total mechanical ventilation rate, etc.) (all P>0.05). Conclusions Compared with InSurE technology, non-Magill forceps-assisted LISA technique is safe and feasible, but whether it can reduce the incidence of BPD and mortality remains to be further investigated.

Key words: neonatal respiratory distress syndrome; less invasive surfactant administration; bronchopulmonary dysplasia; premature