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Background  In recent years, nasal intermittent positive pressure ventilation (NIPPV) has been growing in popularity as a form of noninvasive ventilation for respiratory support in the initial treatment of neonates with surfactant (SF) deficiency. The combination of this type of ventilation with noninvasive SF administration (by nebulization) is an attractive treatment option for respiratory distress syndrome (RDS)‐associated pathophysiology of the neonatal lungs. In this study, we aimed to test the tolerability and efficacy of SF nebulization during NIPPV for the treatment of neonatal RDS.    Methods  Spontaneously‐breathing newborn piglets ( n  = 6/group) with bronchoalveolar lavage (BAL)‐induced RDS were assigned to receive during NIPPV (180 min): poractant alfa (400 mg/kg) via an investigational customized vibrating‐membrane nebulizer (eFlow‐Neos) or poractant alfa (200 mg/kg) as a bolus using the Insure method or no surfactant (controls).    Measurement and results  We assessed pulmonary, hemodynamic and cerebral effects and performed histological analysis of lung and brain tissue. After repeated BAL, newborn piglets developed severe RDS (F iO2 : 1, pH < 7.2, P aCO2  > 70 mmHg, P aO2 < 70 mmHg, C dyn  < 0.5 ml/cmH 2 O/kg). In both SF‐treated groups, we observed rapid improvement in pulmonary status and also similar hemodynamic, cerebral behavior, and lung and brain injury scores.    Conclusion  Our results in newborn piglets with severe BAL‐induced RDS show the administration of nebulized poractant alfa using the eFlow‐Neos nebulizer during NIPPV to be well tolerated and efficacious, suggesting that this noninvasive SF administration option should be explored further.

Surfactant nebulization therapy during NIPPV ventilation in surfactant‐deficient newborn piglets