title: Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants.
abstract: OBJECTIVE
  Providing less invasive surfactant administration (LISA) to spontaneously breathing preterm infants has been reported to reduce mechanical ventilation and bronchopulmonary dysplasia (BPD) in randomised controlled trials. This large cohort study compared these outcome measures between LISA-treated infants and controls.
  
  
  METHODS
  Infants receiving LISA, who were born before 32 gestational weeks and enrolled in the German Neonatal Network, were matched to control infants by gestational age, umbilical cord pH, Apgar-score at 5 min, small for gestational age status, antenatal treatment with steroids, gender and highest supplemental oxygen during the first 12 h of life. Outcome data were compared with chi-square and Mann-Whitney U-tests and adjusted for multiple comparisons.
  
  
  RESULTS
  Between 2009 and 2012, 1103 infants were treated with LISA at 37 centres. LISA infants had lower rates of mechanical ventilation (41% versus 62%, p < 0.001), postnatal dexamethasone treatment (2.5% versus 7%, p < 0.001), BPD (12% versus 18%, p = 0.001) and BPD or death (14% versus 21%, p < 0.001) than the controls.
  
  
  CONCLUSIONS
  Surfactant treatment of spontaneously breathing infants was associated with lower rates of mechanical ventilation and BPD. Additional large-scale randomised controlled trials are needed to assess the possible long-term benefits of LISA.
authors.affiliation: Department of Pediatrics, University of Lübeck, Lübeck, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Göpel
authors.forename: Angela
authors.initials: A
authors.lastname: Kribs
authors.forename: Christoph
authors.initials: C
authors.lastname: Härtel
authors.forename: Stefan
authors.initials: S
authors.lastname: Avenarius
authors.forename: Norbert
authors.initials: N
authors.lastname: Teig
authors.forename: Peter
authors.initials: P
authors.lastname: Groneck
authors.forename: Dirk
authors.initials: D
authors.lastname: Olbertz
authors.forename: Claudia
authors.initials: C
authors.lastname: Roll
authors.forename: Matthias
authors.initials: M
authors.lastname: Vochem
authors.forename: Ursula
authors.initials: U
authors.lastname: Weller
authors.forename: Axel
authors.initials: A
authors.lastname: von der Wense
authors.forename: Christian
authors.initials: C
authors.lastname: Wieg
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wintgens
authors.forename: Michael
authors.initials: M
authors.lastname: Preuss
authors.forename: Andreas
authors.initials: A
authors.lastname: Ziegler
authors.forename: Bernhard
authors.initials: B
authors.lastname: Roth
authors.forename: Egbert
authors.initials: E
authors.lastname: Herting
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D016555:Matched-Pair Analysis; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000008:administration & dosage* / Q000627:therapeutic use; D012119:Respiration; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D011663:Pulmonary Surfactants
keywords: Bronchopulmonary dysplasia; Less invasive surfactant administration; Mechanical ventilation; Preterm infant; Spontaneous breathing