title: Survey shows large differences between the Nordic countries in the use of less invasive surfactant administration.
abstract: OBJECTIVE
  Less invasive surfactant administration (LISA), namely surfactant instillation through a thin catheter in the trachea during spontaneous breathing, is increasingly used for premature infants. We surveyed the use of this technique in the Nordic countries in autumn 2015.
  
  
  METHODS
  A link to a web-based survey of surfactant administration methods was emailed to the directors of all neonatal units in the Nordic Region, apart from Finland, where only the five university-based departments were invited.
  
  
  RESULTS
  Of the 73 units (85%) who responded, 23 (32%) said that they used LISA. The country rates were Iceland 100%, Norway 82%, Finland 60%, Denmark, including Faroe Island and Greenland, 11% and Sweden 9%. LISA was used in 62% of level three units, but only 14% of level two units and most commonly in babies with a gestational age of at least 26 weeks. Premedication was always or sometimes used by 78%. The main reasons for not using LISA were lack of familiarity with the technique (61%), no perceived benefit over other methods (22%) and concerns about patient discomfort (26%).
  
  
  CONCLUSIONS
  Less invasive surfactant administration was used in 32% of Nordic neonatal units, most commonly in level three units. Premedication was used more often than previously reported.
authors.affiliation: Department of Neonatology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Heiring
authors.affiliation: Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden.|Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
authors.forename: Baldvin
authors.initials: B
authors.lastname: Jonsson
authors.affiliation: Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Sture
authors.initials: S
authors.lastname: Andersson
authors.affiliation: Department of Paediatric Surgery and Neonatology, Skåne University Hospital, Lund, Sweden.|Department of Clinical Sciences, University of Lund, Lund, Sweden.
authors.forename: Lars J
authors.initials: LJ
authors.lastname: Björklund
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D015931:Intensive Care, Neonatal / Q000379:methods / Q000706:statistics & numerical data; D009359:Neonatology / Q000379:methods / Q000706:statistics & numerical data; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy*; D012537:Scandinavian and Nordic Countries; D011795:Surveys and Questionnaires
chemical_list: D011663:Pulmonary Surfactants
keywords: Less invasive surfactant administration; Nordic countries; Premature infants; Respiratory distress syndrome; Web-based survey