Less invasive surfactant administration in extremely preterm infants: impact on mortality and morbidity

Neonatology. 2013;103(4):252-8. doi: 10.1159/000346521. Epub 2013 Feb 22.


Background: A new mode of surfactant administration without intubation - less invasive surfactant administration (LISA) - has recently been described for premature infants.

Objective: We report single-center outcome data of extremely premature infants who have been managed by LISA in our department. Mortality and morbidity rates of the cohort were compared to historical controls from our own center and to data of the Vermont-Oxford Neonatal Network (VONN).

Patients and methods: All infants born at 23-27 weeks' gestational age during 01/2009 and 06/2011 (n = 224) were managed by LISA and included in the study group.

Results: LISA was tolerated by 94% of all infants. 68% of infants stayed on continuous positive airway pressure on day 3. The rate of mechanical ventilation was 35% within the first week and 59% during the entire hospital stay. Compared to historical controls, we found significantly higher survival rates (75.8 vs. 64.1%) and significantly less intraventricular hemorrhage (IVH) (28.1 vs. 45.9%), severe IVH (13.1 vs. 23.9%) and cystic periventricular leukomalacia (1.2 vs. 5.6%); only persistent ductus arteriousus (PDA) (74.7 vs. 52.6%) and retinopathy of prematurity (ROP) (40.5 vs. 21.1%) occurred significantly more often. Compared to VONN data, we found significantly less chronic lung disease (20.6 vs. 46.4%), severe cerebral lesions (IVH 3/4 + cystic PVL; 9.4 vs. 16.1%) and ROP (all grades) (40.5 vs. 56.5%); only PDA (74.7 vs. 63.1%) and severe ROP (> grade 2) (24.1 vs. 14.1%) occurred significantly more often in our cohort.

Conclusion: Surfactant can be effectively and safely delivered via LISA and this is associated with low rates of mechanical ventilation and various adverse outcomes in extremely premature infants.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Austria
  • Catheterization
  • Chi-Square Distribution
  • Combined Modality Therapy
  • Continuous Positive Airway Pressure
  • Drug Administration Routes
  • Feasibility Studies
  • Female
  • Gestational Age
  • Hospital Mortality
  • Humans
  • Infant Mortality
  • Infant, Extremely Premature*
  • Infant, Newborn
  • Infusions, Parenteral
  • Lung / drug effects*
  • Lung / physiopathology
  • Male
  • Pulmonary Surfactants / administration & dosage*
  • Pulmonary Surfactants / adverse effects
  • Respiratory Distress Syndrome, Newborn / drug therapy*
  • Respiratory Distress Syndrome, Newborn / mortality
  • Respiratory Distress Syndrome, Newborn / physiopathology
  • Retrospective Studies
  • Survival Analysis
  • Time Factors
  • Treatment Outcome


  • Pulmonary Surfactants