{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:41:45Z","timestamp":1759970505233,"version":"build-2065373602"},"reference-count":22,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,26]],"date-time":"2025-01-26T00:00:00Z","timestamp":1737849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Pneumothorax is a common complication of neonatal respiratory distress syndrome, which is decreased by surfactant therapy. Rescue administration of surfactant in neonates with severe RDS complicated by pneumothorax requires management of the pneumothorax to optimize surfactant distribution while avoiding positive pressure ventilation to minimize iatrogenic exacerbation of the air leak. Methods: We retrospectively reviewed our center\u2019s experience with neonates who had clinically significant pneumothorax complicating RDS, in whom we used a novel technique to administer surfactant through a laryngeal mask\/supraglottic airway device without applying positive pressure ventilation. Results: In 13 of the 20 neonates in our cohort, subsequent invasive ventilation and chest tube insertion were avoided. There were no major complications or unfavorable outcomes. We describe our experience with this method and suggest an approach to individualize the management of neonates with pneumothorax preceding surfactant therapy. Conclusions: In our setting, laryngeal mask airway devices are now the preferred method to deliver surfactant in neonates with RDS and pre-existing pneumothorax. We believe this approach is readily applicable in most neonatal care settings.<\/jats:p>","DOI":"10.3390\/children12020134","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T04:59:10Z","timestamp":1737953950000},"page":"134","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Laryngeal Mask Airway Method for Minimally Invasive Surfactant Therapy in Neonates with Pneumothorax Complicating Respiratory Distress Syndrome"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3973-7045","authenticated-orcid":false,"given":"Joaquim M. B.","family":"Pinheiro","sequence":"first","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0042-8077","authenticated-orcid":false,"given":"Marilyn","family":"Fisher","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7089-3081","authenticated-orcid":false,"given":"Kate A.","family":"Tauber","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chad","family":"Pezzano","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA"},{"name":"Departments of Pediatrics and Cardiorespiratory Services, Albany Medical Center, Albany, NY 12208, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e2023065373","DOI":"10.1542\/peds.2023-065373","article-title":"Early bubble CPAP protocol implementation and rates of death or severe BPD","volume":"154","author":"Zeid","year":"2024","journal-title":"Pediatrics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"402","DOI":"10.3109\/14767058.2013.818114","article-title":"Pneumothorax in the newborn: Clinical presentation, risk factors and outcomes","volume":"27","author":"Aly","year":"2014","journal-title":"J. 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Fetal Neonatal Ed."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1159\/000453029","article-title":"Neonatal pneumothorax: A descriptive regional Danish study","volume":"111","author":"Vibede","year":"2017","journal-title":"Neonatology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1001\/jamapediatrics.2018.0623","article-title":"Effect of needle aspiration of pneumothorax on subsequent chest drain insertion in newborns: A randomized clinical trial","volume":"172","author":"Murphy","year":"2018","journal-title":"JAMA Pediatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e20153985","DOI":"10.1542\/peds.2015-3985","article-title":"Incidence and outcome of CPAP failure in preterm infants","volume":"138","author":"Dargaville","year":"2016","journal-title":"Pediatrics"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2583","DOI":"10.1002\/ppul.25454","article-title":"Pneumothorax prevalence and mortality per gestational age in the newborn","volume":"56","author":"Acun","year":"2021","journal-title":"Pediatr. Pulmonol."},{"key":"ref_10","first-page":"3","article-title":"Surfactant for tension pneumothorax in term neonates. Dodging chest tubes with a novel approach","volume":"13","author":"Soliman","year":"2018","journal-title":"Neonatol. Today"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1038\/jp.2015.177","article-title":"Randomized trial of laryngeal mask airway versus endotracheal intubation for surfactant delivery","volume":"36","author":"Pinheiro","year":"2016","journal-title":"J. Perinatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jpeds.2022.10.009","article-title":"Randomized trial of surfactant therapy via laryngeal mask airway versus brief tracheal intubation in neonates born preterm","volume":"254","author":"Gallup","year":"2023","journal-title":"J. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e673","DOI":"10.1542\/neo.22-10-e673","article-title":"Surfactant administration through laryngeal or supraglottic airways","volume":"22","author":"Guthrie","year":"2021","journal-title":"NeoReviews"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1177\/000992287701600404","article-title":"Accuracy of transillumination in the recognition of pneumothorax and pneumomediastinum in the neonate","volume":"16","author":"Wyman","year":"1977","journal-title":"Clin. Pediatr."},{"key":"ref_15","first-page":"242","article-title":"The factors affecting persistent pneumothorax and mortality in neonatal pneumothorax","volume":"50","author":"Esme","year":"2008","journal-title":"Turk. J. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1001\/jama.2010.1015","article-title":"Respiratory morbidity in late preterm births","volume":"304","author":"Hibbard","year":"2010","journal-title":"JAMA"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1038\/s41372-024-01899-2","article-title":"Pneumothorax in a term newborn","volume":"44","author":"Jhaveri","year":"2024","journal-title":"J. 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Scand."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"6515069","DOI":"10.1155\/2016\/6515069","article-title":"Lung ultrasound diagnostic accuracy in neonatal pneumothorax","volume":"2016","author":"Cattarossi","year":"2016","journal-title":"Can. Respir. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1136\/archdischild-2020-320438","article-title":"Laryngeal mask airway surfactant administration: Case series of 60 infants","volume":"106","author":"Smee","year":"2021","journal-title":"Arch. Dis. Child. 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