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

Objective: 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. Study design: 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. Results: 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). Conclusions: 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.