To probe into the clinical efficacy of nasal duo positive airway pressure (DuoPAP) combined with less invasive pulmonary surfactant (PS) administration (LISA) technique at different time points in the treatment of premature infants with respiratory distress syndrome (RDS). Methods: A total of 58 premature infants with RDS admitted into Zhengzhou People’s Hospital from Jun. 2017 to Jun. 2018 were extracted to be divided into the early LISA group (n=30) and the remedial LISA group (n=28) via the random number table. In the early LISA group

DuoPAP was given

the gastric tube was placed into the trachea

PS was slowly injected through the gastric tube

DuoPAP was given during the injection

and the gastric tube was removed and DuoPAP was continued after the injection was completed. Children in the remedial LISA group were given DuoPAP

if progressive worsening dyspnea occurred

the gastric tube was placed into the trachea

and PS was slowly injected through the gastric tube remedially

and the gastric tube was removed and DuoPAP was continued after the injection was completed. The proportion of children requiring mechanical ventilation

length of stay and hospitalization costs were compared between two groups

and the incidences of pneumothorax

pneumonia

bronchopulmonary dysplasia (BPD) and intracranial hemorrhage (ICH) were recorded. Results: There were no statistically significant differences between two groups in the proportion of children requiring mechanical ventilation

duration of noninvasive ventilation

incidence of pneumonia

length of stay

incidence of pneumothorax

BPD and ICH (P>0.05). The hospitalization costs of the remedial LISA group were lower than those of the early LISA group

the difference was statistically significant (P<0.05). Conclusion: DuoPAP combined with LISA technique can effectively relieve the respiratory distress

reduce the hospitalization costs

and do not increase the incidence of air leakage

BPD

intracranial hemorrhage

and prolong the length of stay.