Figure 1.

Flow diagram. ¹Among these, 27 were outborn patients and 4 patients were intubated in delivery room. ²One patient presented with severe RDS and was intubated because parents were not available to consent to the study. Clinicians decided not to delay surfactant administration. ³Four eligible patients developed a pneumothorax prior to inclusion and randomization. ⁴Three patients were not included by involuntary omission of the attending physician to recruit them. Three patients were intubated soon after NICU admission because the clinician judged that attempting MIST was not appropriate as the infants had a poor respiratory drive. One patient was intubated because the RDS diagnosis was not obvious. ⁵One patient developed a pneumothorax after he was intubated. MIST Minimally invasive surfactant therapy; MV Mechanical ventilation; N Number; NICU Neonatal intensive care unit; RDS Respiratory distress syndrome.