Short-Term Outcomes of Implementing Less Invasive Surfactant Therapy in Infants Born Less than 30 Weeks: A Retrospective Trend Analysis.

Abstract

To evaluate the impact of less invasive surfactant (LISA) therapy implementation on short-term clinical outcomes in infants born less than 30 weeks gestational age (GA) in a real-life setting. This retrospective cohort study included infants born <30 weeks GA between 2009 and 2023 and treated with surfactant. The study period included a pre-LISA epoch (2009-2012), and an epoch when LISA was fully implemented (2018-2023). The primary outcome was death or moderate/severe bronchopulmonary dysplasia (BPD), and its components at 36 weeks postmenstrual age. Outcome data were compared using time trend analysis and multivariable regression analysis adjusting for confounders. Of all the 1502 infants born <30 weeks GA during the study period, 725 infants (48.3%) were included. Of these infants, 189 (26.1%) were born in the pre-LISA epoch, 259 (35.7%) during the LISA implementation period (2013-2017), and 277 (38.2%) in the LISA epoch. Over time, LISA use increased from 0% to 83.0%, while endotracheal tube surfactant decreased from 100% to 47.2%. LISA implementation had no effect on the composite outcome death or BPD (adjusted odds ratio 0.88, 95% CI 0.70, 1.10). The risk of death, but not BPD, was lower in the LISA compared with the pre-LISA epoch (adjusted odds ratio 0.62, 95% CI 0.48-0.79). The implementation of LISA in preterm infants was feasible but not associated with a reduction in the combined outcome death or BPD, although the results do suggest that LISA improved survival. Additional studies need to assess the long-term effects of LISA.