Observational Study on Less Invasive Surfactant Administration (LISA) in Preterm Infants<29 Weeks--Short and Long-term Outcomes.

BACKGROUND: A recent trial has demonstrated short-term benefits of a new minimal invasive procedure of surfactant administration in spontaneously breathing preterm infants ≥ 26 weeks (less invasive surfactant administration, LISA). AIM: To assess safety as well as short- and long-term outcomes of the LISA procedure in preterm infants between 23-28 weeks of gestation. STUDY
DESIGN: Preterm infants born between 23+0 and 28+6 weeks gestational age during 2 periods, 18 months before (Period 1, n=44) and 18 months after introduction of LISA (Period 2, n=53), were analyzed for neonatal outcomes. 52% of discharged infants were assessed for neurodevelopmental outcome at corrected age of 3 years.
RESULTS: In Period 2, 66% of the preterm infants needing surfactant were treated by the new method of LISA. In this period, fewer patient had to be ventilated during the first 3 days of life (42 vs. 77%, p<0.0005) and overall (55 vs. 77%, p=0.02). The median duration of mechanical ventilation was 2 vs. 3 days (p=0.056). Survival without BPD was 68% in period 1 and 74% in period 2 (p=0.29). In period 2, fewer infants received antibiotics after the third day of life (43 vs. 66%, p=0.04), systemic glucocorticoids were less frequently used (7.5 vs. 23%, p=0.04), and more infants received doxapram (34 vs. 2.3%, p<0.0001). Mental Developmental Index (89 vs. 98, p=0.16) and Physical Developmental Index (83 vs. 91, p=0.03) at 3 years improved between the 2 periods.
CONCLUSION: Implementation of the LISA method on a neonatal ward was safe and feasible and was associated with less need for mechanical ventilation in infants >24 weeks. As our study was retrospective the observed trends for better pulmonary and neurocognitive outcomes should be interpreted with caution until results from randomized trials on the LISA procedure are available. © Georg Thieme Verlag KG Stuttgart · New York.