Outcomes following less-invasive-surfactant-administration in the delivery-room

Background: Less invasive surfactant administration (LISA) on the neonatal unit reduces the need for mechanical ventilation and bronchopulmonary dysplasia (BPD). Aims: To assess the immediate and longer-term efficacy of LISA to prematurely born infants in the delivery-room. Study design: A case control study with inborn historical controls matched for gestational age, birthweight and gender to each LISA infant. Subjects: Infants born between 26+0 weeks and 34+6 weeks of gestational age. Outcome measures: Respiratory function monitoring before and after LISA and need for mechanical ventilation within 72 h of birth. Results: Ninety-nine infants, median gestational age of 32(+4)(range:27(+0)-34(+6)) weeks, were prospectively recruited. The respiratory rate and inspired oxygen (FiO(2)) decreased two minutes after LISA and there was a reduction in the FiO(2) requirement at two hours post birth. Compared to historical controls, LISA administration was associated with a reduction in the need for mechanical ventilation within 72 h after birth (20.2% versus 56.6% p < 0.001) the incidence of moderate to severe BPD (8.2% versus 20.2%, p = 0.02) and the median costs of neonatal intensive care stay (1218 pound versus 2436 pound, p = 0.03) and total neonatal unit stay (12,888 pound versus 17,240 pound, p = 0.04). A high FiO(2) in the delivery-room pre-LISA (median 0.75 versus 0.60, p = 0.02) was associated with LISA failure, that is mechanical ventilation within 72 h of birth. Conclusions: LISA to prematurely born infants in the delivery-room was associated with reductions in the need for mechanical ventilation and costs of care, but was less successful in those with initial, more severe respiratory disease.