title: European perspective on less invasive surfactant administration-a survey.
abstract: Less invasive surfactant administration or minimally invasive surfactant therapy (LISA/MIST) has been proposed for the administration of surfactant in preterm infants without intubation. The aim of our survey was to assess the rate of utilization, premedication as well as technique and equipment used for LISA/MIST. Furthermore, attitudes and experiences in regard to indications, side effects, and efficacy should be assessed. An online-based survey was sent to 324 neonatologists from different centers within 37 European countries between December 2015 and March 2016. Of those 165 who responded (response rate 51%), 86 (52%) were using LISA/MIST. It is regarded the standard procedure for surfactant administration by 41%, with a wide variation in personal views on patient selection in terms of indication, appropriate gestational and postnatal age. Policies concerning premedication, devices, and technique of LISA/MIST differed widely. Side effects like surfactant reflux, bradycardia, and hypoxia were observed by 77% of neonatologists. Of neonatologists inexperienced in LISA/MIST, 89% would consider utilizing it in the future. Perceived efficacy of LISA/MIST was high (52%) to medium (33%).
  
  
  CONCLUSIONS
  The use of LISA/MIST within Europe is widespread. There is a wide variation concerning all aspects of LISA in daily clinical routine and different views on when and how LISA should be performed. What is Known: • Noninvasive surfactant administration has been the subject of randomized controlled trials and has found its way into clinical routine. What is New: • Noninvasive surfactant administration techniques are widely applied in European neonatal units. • There is a wide variety of equipment used and techniques applied for less invasive surfactant delivery as well as different views on the indications and perceived efficacy of this intervention.
authors.affiliation: Center for Pediatrics, Department of Neonatology, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany. daniel.klotz@uniklinik-freiburg.de.|Faculty of Medicine, University of Freiburg, Freiburg, Germany. daniel.klotz@uniklinik-freiburg.de.
authors.forename: Daniel
authors.identifier: http://orcid.org/0000-0003-2347-3866
authors.initials: D
authors.lastname: Klotz
authors.affiliation: Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Porcaro
authors.affiliation: Center for Pediatrics, Department of Pediatric Cardiology, Heart Center - University of Freiburg, Freiburg, Germany.|Faculty of Medicine, University of Freiburg, Freiburg, Germany.
authors.forename: Thilo
authors.initials: T
authors.lastname: Fleck
authors.affiliation: Center for Pediatrics, Department of Neonatology, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.|Faculty of Medicine, University of Freiburg, Freiburg, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Fuchs
mesh_terms: D001919:Bradycardia / Q000453:epidemiology; D005060:Europe; D005865:Gestational Age; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology; D007231:Infant, Newborn; D007234:Infant, Premature; D015931:Intensive Care, Neonatal / Q000379:methods* / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000379:methods* / Q000706:statistics & numerical data; D009359:Neonatology / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011292:Premedication; D011663:Pulmonary Surfactants / Q000008:administration & dosage* / Q000009:adverse effects; D012127:Respiratory Distress Syndrome, Newborn; D011795:Surveys and Questionnaires
chemical_list: D011663:Pulmonary Surfactants
keywords: Intubation; Noninvasive ventilation; Preterm infant; Surfactant; Survey