Integrating Synchronized Nasal Intermittent Positive Pressure Ventilation With Less-Invasive Surfactant Administration: Current Evidence and Evolving Practice in Preterm Neonatal Care.

The objective of this study was to summarize current evidence on the combined use of synchronized nasal intermittent positive pressure ventilation (sNIPPV) and less-invasive surfactant administration (LISA) in the management of respiratory distress syndrome (RDS) in preterm infants. We conducted a narrative review of randomized controlled trials, comparative-effectiveness studies, meta-analyses, the 2022 European Consensus Guidelines on RDS, and recent clinical cohorts evaluating sNIPPV, LISA, and their combined application. Studies suggest that sNIPPV provides superior extubation tolerance and decreases apnea frequency compared with standard continuous positive airway pressure (CPAP). Compared with the intubation, surfactant administration, and extubation (INSURE) approach, LISA lowers early mechanical ventilation needs and decreases bronchopulmonary dysplasia (BPD) rates. When applied together, the two strategies appear to improve procedural stability and decrease the likelihood of re-intubation, and may thus contribute to lower BPD rates due to their complementary physiologic effects. The sNIPPV-LISA combination is physiologically complementary and clinically promising. Current evidence supports a reduced rate of respiratory failure and a trend toward reduced BPD compared with CPAP and the INSURE technique of surfactant administration. Larger randomized trials are required to determine its effects on long-term outcomes.