The growing enthusiasm for less invasive surfactant administration (LISA) techniques is enabling more and more infants to be treated for RDS without the need for mechanical ventilation. As trials of LISA have shown improved outcomes in infants at high risk, it is difficult to know what the required evidence will be to influence practice in lower risk infants or with the use of further variants of LISA. Supraglottic airway devices offer another approach to LISA. This has the added appeal of avoiding direct laryngoscopy, which many understandably consider still to be quite invasive. Callum Roberts and colleagues present a narrative review of the evidence to date regarding use of supraglottic airway devices in this way. Trials so far have included just over 350 infants with encouraging reductions in the need for mechanical ventilation. A present limitation is that currently available devices are too large for the smallest infants so that current evidence is largely limited to infants weighing more than 1?kg. Natalie Smee and colleagues report a series of 60 infants weighing 1200?g treated using a laryngeal mask airway in 2 Scottish neonatal units. All the infants had sustained supplemental oxygen requirements on CPAP before treatment. Device application and surfactant administration was successful in all cases and later intubation for further treatment was required in 10 infants.
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