Abstract
Objectives: To examine the success rate of less invasive surfactant
administration (LISA), to identify early predictive factors for the
outcome of LISA and to compare neonatal outcomes between the LISA
failure group and the group of infants who were succesfully treated with
LISA. Design: A retrospective cohort study. Patients: Infants born at
less than 33 weeks of gestation (n=158) and treated with LISA for
respiratory distress syndrome. Results: LISA was successful in 86 cases
(54.4%), 72 preterm infants (45.6%) needed additional surfactant
therapy and/or mechanical ventilation in the first 72 hours. In a
multivariate logistic regression analysis, six independent predictors
were identified: core temperature at the time of admission (adjusted OR
3.56), suboptimal dose of surfactant (adjusted OR 0.254), elevated CRP
(>10 mg/L) at 24 hours of life (adjusted OR 0.28), highest
respiratory severity score during the first hour of life or at the time
of LISA (adjusted OR 0.463), maternal age (adjusted OR 0.923) and birth
weight (adjusted OR 1.003). The ROC curve created by using the
identified factors indicates good predictive power with an area under
the curve of 0.85. LISA failure was associated with a substantially
higher risk of pneumothorax, bronchopulmonary dysplasia,
intraventricular hemorrhage, severe retinopathy of prematurity, longer
duration of mechanical ventilation and prolonged length of hospital
stay. Conclusion: Failure of LISA is relatively frequent event in very
preterm infants and is associated with adverse outcomes. Prevention of
hypothermia during early stabilization and appropriate dosing of
surfactant increase may LISA success rates and improve patient outcome.