Non-invasive modes of respiratory support have been shown to be the preferable way of primary respiratory support of preterm infants with respiratory distress syndrome (RDS). The avoidance of invasive mechanical ventilation can be beneficial for preterm infants in reduction of morbidity and even mortality. However, it is well-established that some infants managed with non-invasive respiratory support from the outset have symptomatic RDS to a degree that warrants surfactant administration. Infants for whom non-invasive respiratory support ultimately fails are prone to adverse outcomes, occurring at a frequency on par with the group intubated primarily. This raises the question how to combine non-invasive respiratory support with surfactant therapy. Several methods of less or minimally invasive surfactant therapy have been developed to address the dilemma between avoidance of mechanical ventilation and administration of surfactant. This paper describes the different methods of less invasive surfactant application, reports the existing evidence from clinical studies, discusses the limitations of each of the methods and the open and future research questions.

无创呼吸支持模式已被证明是患有呼吸窘迫综合征（RDS）的早产儿首选的主要呼吸支持方式。避免有创机械通气有利于早产儿降低发病率甚至死亡率。然而，众所周知，一些从一开始就接受非侵入性呼吸支持的婴儿患有 RDS 症状，其程度需要使用表面活性剂。无创呼吸支持最终失败的婴儿很容易出现不良后果，其发生频率与初次插管的婴儿相同。这就提出了如何将无创呼吸支持与表面活性剂治疗结合起来的问题。已经开发了几种少或微创表面活性剂治疗方法来解决避免机械通气和施用表面活性剂之间的困境。本文描述了微创表面活性剂应用的不同方法，报告了临床研究的现有证据，讨论了每种方法的局限性以及开放和未来的研究问题。