Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 6 2019 11 17 348 354 EN Elaheh Amini Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mahdi Sheikh Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mamak Shariat Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. Hosein Dalili Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. Negin Azadi Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. Sajjad Nourollahi Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2018 12 03 2019 09 08 In this study, we aimed to compare the efficacy of laryngeal mask airway (LMA) versus endotracheal tube in the early rescue surfactant administration in premature neonates with respiratory distress syndrome (RDS). This randomized, clinical trial evaluated 60 premature neonates with RDS. Numbered envelopes randomly assigned 30 neonates to the intervention group to receive 2.5 ml/kg/dose surfactant (Curosurf) via LMA and 30 to the control group to receive 2.5 ml/kg/dose surfactant via an endotracheal tube using the INSURE technique, exclusively during the first two hours of life. There were no differences in the requirement for mechanical ventilation (23.3% vs. 20%, P=0.75), requirement for second dose surfactant (13.3% vs. 6.7%, P=0.67), bronchopulmonary dysplasia (13.3% vs. 6.7%, P=0.67), pneumothorax (6.7% vs. 0%, P=0.49), and intraventricular hemorrhage (10% vs. 10%, P=1) between neonates who received surfactant via LMA versus those who received surfactant via endotracheal tube. LMA seems to be an effective and less invasive alternative to endotracheal intubation for surfactant delivery in premature neonates with RDS. https://acta.tums.ac.ir/index.php/acta/article/view/7614 https://acta.tums.ac.ir/index.php/acta/article/download/7614/5272