BACKGROUND: The primary aim of this randomized study was to describe the 
feasibility of early administration of surfactant via a thin catheter during 
spontaneous breathing (Take Care) and compare early mechanical ventilation (MV) 
requirement with the InSurE (Intubate, Surfactant, Extubate) procedure.
METHODS: Preterm infants, who were <32 weeks and stabilized with nasal 
continuous positive airway pressure (nCPAP) in the delivery room, were 
randomized to receive early surfactant treatment either by the Take Care or 
InSurE technique. Tracheal instillation of 100 mg/kg poractant α via 5-F 
catheter during spontaneous breathing under nCPAP was performed in the 
intervention group. In the InSurE procedure, infants were intubated, received 
positive pressure ventilation for 30 seconds after surfactant instillation, and 
placed on nCPAP immediately.
RESULTS: One hundred infants in each group were analyzed. The MV requirement in 
the first 72 hours of life was significantly lower in the Take Care group when 
compared with the InSurE group (30% vs 45%, P = .02, odds ratio -0.52, 95% 
confidence interval -0.94 to -0.29). Mean duration of both nCPAP and MV were 
significantly shorter in the Take Care group (P values .006 and .002, 
respectively). Bronchopulmonary dysplasia rate was significantly lower among the 
infants treated with the Take Care technique (relative risk -0.27, 95% 
confidence interval -0.1 to -0.72)
CONCLUSIONS: The Take Care technique is feasible for the treatment of 
respiratory distress syndrome in infants with very low birth weight. It 
significantly reduces both the need and duration of MV, and thus the 
bronchopulmonary dysplasia rate in preterm infants.