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For extremely preterm infants with potential respiratory distress syndrome, less invasive surfactant administration (LISA) was associated with a significant decrease in the risk of adverse outcomes, a cohort study found.

There was a drop in requirement for invasive mechanical ventilation between those infants receiving LISA within the first 72 hours of life and those who didn't (53.6% vs 8.3%), according to the study of over 6,500 infants in Germany.

Often performed early in the delivery room, LISA was safe and associated with decreased risks during the child's primary stay in hospital:

• All-cause death (adjusted OR 0.74, 95% CI 0.61-0.90)
• Bronchopulmonary dysplasia (BPD; adjusted OR 0.69, 95% CI 0.62-0.78, P<0.001)
• BPD or death (adjusted OR 0.64, 95% CI 0.57-0.72, P<0.001)

Babies undergoing LISA also showed reductions in pneumothorax and retinopathy of prematurity, Christoph Härtel, MD, from University Hospital of Würzburg in Germany, and colleagues reported in .

LISA comprises less invasive delivery of surfactant to babies in respiratory distress. Important concepts of LISA include delayed cord clamping, facilitated fetal transition, initial continuous positive airway pressure support, maintenance of spontaneous breathing, caffeine administration, and early skin-to-skin contact, according to Härtel's team.

The authors noted that LISA had been found to be beneficial for respiratory outcomes in earlier studies. Theirs may be the first large-scale report in "the most vulnerable preterm population," however.

Last year's trial showed a nonsignificant trend of better survival in infants born at 25 to 28 weeks who received surfactant treatment.

Härtel and colleagues based their observational cohort study on the German Neonatal Network of 68 tertiary level neonatal ICUs. Infants born from 22 weeks 0 days to 26 weeks 6 days of gestation between April 2009 and December 2020 were eligible.

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

Outcomes were adjusted for gestational age, small-for-gestational-age status, sex, multiple birth, inborn status, antenatal steroid use, and maximum fraction of inspired oxygen in the first 12 hours.

Nevertheless, some potential confounders may have been missed by the study authors.

They also acknowledged the potential for indication bias and selection bias, as well as the possibility that LISA does not avoid mechanical ventilation in some babies. "There is still an urgent need to better define those babies at high risk for failing a treatment strategy that includes LISA."

Randomized clinical trials are needed to assess the effects of prophylactic LISA on vulnerable preterm infants, Härtel's team suggested.

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