Less invasive surfactant administration reduces adverse outcomes in infants


A study by the German Neonatal Network associated application of less invasive surfactant administration with fewer complications and lower mortality rates.

Less invasive surfactant administration (LISA) may reduce risk of adverse outcomes in early preterm infants, according to a study published by the Journal of the American Medical Association.

Data was analyzed from 68 tertiary level neonatal intensive care units in Germany, showing the results of infants treated with LISA compared to those not treated with LISA. These infants were born between 22 weeks 0 days and 26 weeks 6 days of gestation. 

With parental consent, a total of 9378 infants were enrolled in a program within the German Neonatal Network. Data was recorded on the infants from the time until discharge, then analyzed by a study team neonatologist.

Infants were tested for conditions such as periventricular leukomalacia and bronchopulmonary dysplasia (BPD). Mortality rates were also observed. It was considered a failure of LISA if invasive mechanical ventilation was needed within 72 hours after LISA was applied.

For accurate data, multiple variables were considered. Multivariate logistic regression included gestation age (GA), sex, inborn status, small-for-gestational-age (SGA) status, multiple birth, antenatal steroid use, and maximum FiO2 in the first 12 hours of life. Further variables were added in a second study involving 6170 infants. These include study site, year of discharge, and confounding variables affecting the infant’s breathing capacity.

Over half of the infants given LISA did not need mechanical ventilation within 72 hours, while only about 8% of infants not given LISA did not need mechanical ventilation during the same time period. The study results implied that LISA led to reduced risks of all-cause death.

The data suggest that LISA leads to less short-term complications such as BPD or pneumothoraxin infants. The mortality rate also drastically decreased with application of LISA. Further, infants not given LISA had a lower GA and weight. 

Throughout the study, safety risks associated with LISA did not appear, with lower risks of complications and mortality observed. In cases of LISA failure, factors included male sex, low GA, lower Apgar scores, lack of antenatal steroid use, study site, SGA status, and maximum FiO2 levels. This data matches that of previous studies involving LISA use.


Härtel C, Herting E, Humberg A, et al. Association of administration of surfactant using less invasive methods with outcomes in extremely preterm infants less than 27 weeks of gestation. JAMA Network Open. 2022;5(8):e2225810. doi:10.1001/jamanetworkopen.2022.25810

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