Less Invasive Surfactant Administration Versus Intubate-Surfactant-Extubate: Associated With Reduced Mechanical Ventilation in Extremely Preterm Infants

AIM: To compare less invasive surfactant administration (LISA) and intubation-surfactant-extubation (INSURE) in infants born before 28 weeks gestational age (GA) by the need for mechanical ventilation (MV).

METHODS: LISA was introduced in 2017 in our unit without formal prior LISA-specific training as an equal alternative to INSURE. Medical records (July 2017 to July 2021) were reviewed for infants born < 28 weeks gestation treated with LISA or INSURE. The primary outcome was needing MV within 72 h, adjusted for potential confounders (including gestational age, birthweight, sex, mode of delivery and FiO2) using logistic regression. Secondary outcomes included MV duration, respiratory support duration, first-pass success rate in endotracheal tube or LISA catheter placement and neonatal morbidities.

RESULTS: A total of 108 infants (median 26 weeks GA) were included: 51 receiving LISA, 57 receiving INSURE. LISA was associated with a lower need for MV within 72 h (aOR: 0.40, 95% CI: 0.17-0.94) and during admission (aOR: 0.199, [0.075; 0.529]), although the duration of MV and any respiratory support were similar. The first-pass success rate was high in both groups (75%). There were no differences in other secondary outcomes.

CONCLUSION: LISA was associated with a reduced need for MV compared to INSURE, even when implemented without prior formal training.