Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants

AimProviding less invasive surfactant administration (LISA) to spontaneously breathing preterm infants has been reported to reduce mechanical ventilation and bronchopulmonary dysplasia (BPD) in randomised controlled trials. This large cohort study compared these outcome measures between LISA-treated infants and controls. MethodsInfants receiving LISA, who were born before 32 gestational weeks and enrolled in the German Neonatal Network, were matched to control infants by gestational age, umbilical cord pH, Apgar-score at 5min, small for gestational age status, antenatal treatment with steroids, gender and highest supplemental oxygen during the first 12h of life. Outcome data were compared with chi-square and Mann-Whitney U-tests and adjusted for multiple comparisons. ResultsBetween 2009 and 2012, 1103 infants were treated with LISA at 37 centres. LISA infants had lower rates of mechanical ventilation (41% versus 62%, p<0.001), postnatal dexamethasone treatment (2.5% versus 7%, p<0.001), BPD (12% versus 18%, p=0.001) and BPD or death (14% versus 21%, p<0.001) than the controls. ConclusionSurfactant treatment of spontaneously breathing infants was associated with lower rates of mechanical ventilation and BPD. Additional large-scale randomised controlled trials are needed to assess the possible long-term benefits of LISA.