Less Invasive Surfactant Administration Versus Intubate-Surfactant-Extubate: Associated With Reduced Mechanical Ventilation in Extremely Preterm Infants.

Aim: To compare less invasive surfactant administration (LISA) and intubation-surfactant-extubation (INSURE) in infants born before 28 weeks gestational age (GA) by the need for mechanical ventilation (MV).

Methods: LISA was introduced in 2017 in our unit without formal prior LISA-specific training as an equal alternative to INSURE. Medical records (July 2017 to July 2021) were reviewed for infants born < 28 weeks gestation treated with LISA or INSURE. The primary outcome was needing MV within 72 h, adjusted for potential confounders (including gestational age, birthweight, sex, mode of delivery and FiO₂) using logistic regression. Secondary outcomes included MV duration, respiratory support duration, first-pass success rate in endotracheal tube or LISA catheter placement and neonatal morbidities.

Results: A total of 108 infants (median 26 weeks GA) were included: 51 receiving LISA, 57 receiving INSURE. LISA was associated with a lower need for MV within 72 h (aOR: 0.40, 95% CI: 0.17-0.94) and during admission (aOR: 0.199, [0.075; 0.529]), although the duration of MV and any respiratory support were similar. The first-pass success rate was high in both groups (75%). There were no differences in other secondary outcomes.

Conclusion: LISA was associated with a reduced need for MV compared to INSURE, even when implemented without prior formal training.