title: Less invasive surfactant administration in extremely preterm infants: impact on mortality and morbidity.
abstract: BACKGROUND
  A new mode of surfactant administration without intubation - less invasive surfactant administration (LISA) - has recently been described for premature infants.
  
  
  OBJECTIVE
  We report single-center outcome data of extremely premature infants who have been managed by LISA in our department. Mortality and morbidity rates of the cohort were compared to historical controls from our own center and to data of the Vermont-Oxford Neonatal Network (VONN).
  
  
  METHODS
  All infants born at 23-27 weeks' gestational age during 01/2009 and 06/2011 (n = 224) were managed by LISA and included in the study group.
  
  
  RESULTS
  LISA was tolerated by 94% of all infants. 68% of infants stayed on continuous positive airway pressure on day 3. The rate of mechanical ventilation was 35% within the first week and 59% during the entire hospital stay. Compared to historical controls, we found significantly higher survival rates (75.8 vs. 64.1%) and significantly less intraventricular hemorrhage (IVH) (28.1 vs. 45.9%), severe IVH (13.1 vs. 23.9%) and cystic periventricular leukomalacia (1.2 vs. 5.6%); only persistent ductus arteriousus (PDA) (74.7 vs. 52.6%) and retinopathy of prematurity (ROP) (40.5 vs. 21.1%) occurred significantly more often. Compared to VONN data, we found significantly less chronic lung disease (20.6 vs. 46.4%), severe cerebral lesions (IVH 3/4 + cystic PVL; 9.4 vs. 16.1%) and ROP (all grades) (40.5 vs. 56.5%); only PDA (74.7 vs. 63.1%) and severe ROP (> grade 2) (24.1 vs. 14.1%) occurred significantly more often in our cohort.
  
  
  CONCLUSIONS
  Surfactant can be effectively and safely delivered via LISA and this is associated with low rates of mechanical ventilation and various adverse outcomes in extremely premature infants.
authors: Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria. katrin.klebermass-schrehof@meduniwien.ac.at
authors: Katrin
authors: K
authors: Klebermass-Schrehof
authors: Martin
authors: M
authors: Wald
authors: Jens
authors: J
authors: Schwindt
authors: Agnes
authors: A
authors: Grill
authors: Andrea-Romana
authors: AR
authors: Prusa
authors: Nadja
authors: N
authors: Haiden
authors: Michael
authors: M
authors: Hayde
authors: Thomas
authors: T
authors: Waldhoer
authors: Renate
authors: R
authors: Fuiko
authors: Angelika
authors: A
authors: Berger
mesh_terms: D001317:Austria; D002404:Catheterization; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D045422:Continuous Positive Airway Pressure; D004333:Drug Administration Routes; D005240:Feasibility Studies; D005260:Female; D005865:Gestational Age; D017052:Hospital Mortality; D006801:Humans; D007226:Infant Mortality; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007263:Infusions, Parenteral; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D011663:Pulmonary Surfactants / Q000008:administration & dosage* / Q000009:adverse effects; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011663:Pulmonary Surfactants