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Minimally invasive surfactant delivery for the smallest newborns

Minimally invasive surfactant administration (LISA) significantly reduces the risk of adverse outcomes in very preterm infants with underlying respiratory distress syndrome, a cohort study finds.

According to a study of more than 6,500 infants, the need for invasive mechanical ventilation decreased between infants who received LISA within 72 hours of birth and those who did not (53.6 % versus 8.3%). Germany.

Usually performed early in the delivery room, LISA is safe and associated with reduced risk while the child is hospitalized:

  • All-cause death (adjusted OR 0.74, 95% CI 0.61-0.90)
  • Bronchopulmonary dysplasia (BPD; adjusted Post OR 0.69, 95% CI 0.62-0.78, P
  • BPD or death (adjusted OR 0.64, 95% CI 0.57-0.72, P

LISA also reduces pneumothorax and retinopathy of prematurity in infants receiving LISA, Christoph Härtel, MD, University Hospital Würzburg, Germany, and Colleagues reported at JAMA Network Open.

LISA includes a less invasive surfactant for infants in respiratory distress. According to Härtel’s team, important concepts of LISA include delaying cord clamping, facilitating fetal transition, initial continuous positive airway pressure support, maintenance of spontaneous breathing, caffeine administration, and early skin-to-skin contact.

The authors noted that LISA was found to be beneficial for respiratory outcomes in earlier studies. However, their report may be the first on a large scale in “the most vulnerable preterm population.”

Last year’s OPTIMIST-A trial showed 25 to 28 weeks of surfactant treatment.

Härtel and colleagues conducted an observational cohort study based on 68 tertiary neonatal ICUs of the German Neonatal Network. Infants born between April 2009 and December 2020 at 22 weeks 0 days to 26 weeks 6 days are eligible.

Data from 6,542 infants (mean gestational age 25.3 weeks, 53.7% boys). Of these newborns, 38.7% received LISA.

Results are based on gestational age, small for gestational age status, sex, multiple births, congenital status, antenatal steroid use and proportion of oxygen inhaled in the first 12 hours of maximum.

Nonetheless, the study authors may have missed some potential confounders.

They also acknowledge potential indication and selection bias, and that LISA may not avoid mechanical ventilation in some infants. “There remains an urgent need to better define those infants who are at high risk for failure of treatment strategies including LISA.”

Randomized clinical trials are needed to evaluate the effects of preventive LISA on vulnerable populations impact on premature babies, Härtel’s team advises.

  • James Lopilato is a staff writer for Medpage Today. He covers a variety of topics currently being explored in medical scientific research.


The research was partly funded by the German Ministry of Education and Research (BMBF) and Chiesi.

Härtel reports on various relationships with BMBF, Chiesi, DFG, Pfizer, Merck & Co. Sharp and Dohme, Sanofi and AstraZeneca.



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