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Developmental outcome of extremely preterm infants is improved after less invasive surfactant application:
Katrin Mehler1, Alexander Broer1, Claudia Roll2
1Department of Pediatrics, University of Cologne, Cologne, Germany.
Insights
Less invasive surfactant application (LISA) in preterm infants showed improved neurodevelopmental outcomes. LISA-treated infants had fewer developmental delays at 24 months, suggesting a potentially superior method for surfactant delivery.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Respiratory Care
Background:
- Preterm infants born at 23-26 weeks gestational age face significant neurodevelopmental risks.
- Surfactant administration is crucial for lung maturation but traditional methods carry risks.
- Less invasive surfactant application (LISA) offers a potentially gentler alternative.
Purpose of the Study:
- To evaluate the neurocognitive outcomes at 24 months corrected age in preterm infants.
- To compare outcomes between infants receiving surfactant via LISA and endotracheal intubation.
- To assess the safety and efficacy of LISA in extremely preterm infants.
Main Methods:
- A cohort of 156 preterm infants (23-26 weeks GA) were assessed at 24 months corrected age.
- Participants were divided into two groups: LISA (n=78) and endotracheal intubation (n=78).
- Neurodevelopmental outcomes (PDI, MDI), hearing, vision, growth, and rehospitalization were evaluated, with confounding factors considered.
Main Results:
- LISA-treated infants had significantly lower rates of psychomotor development index (PDI) <70 (22% vs 42%).
- In infants born at 25-26 weeks GA, LISA was associated with significantly lower rates of mental development index (MDI) <70 (4% vs 21%).
- No significant differences were observed in MDI for the entire cohort, but LISA showed a trend towards better outcomes.
Conclusions:
- Less invasive surfactant application (LISA) is safe and associated with reduced rates of severe neurodevelopmental disability in preterm infants.
- LISA may be a superior method for surfactant delivery compared to traditional endotracheal intubation in this vulnerable population.
- Further research is warranted to confirm the long-term benefits of LISA.
Aim:
The aim of this study was to evaluate neurocognitive outcome at 24 months of corrected age after less invasive surfactant application (LISA) in preterm infants born at 23-26 weeks of gestational age.
Methods:
Surviving participants of a LISA trial conducted in 13 German level III neonatal intensive care units were reviewed for assessment of developmental outcome, hearing and vision problems, growth and rehospitalisation days. Maternal depression, breastfeeding rates and socio-economic factors were evaluated as potentially confounding factors.
Results:
In total, 156/182 infants took part in the study, 78 had received surfactant via LISA and 78 via endotracheal intubation. 22% of LISA infants compared to 42% of intubated infants had a psychomotor development index (PDI) <70 (0.012). A significant difference in mental development index (MDI) was observed in the stratum of more mature infants (25 and 26 weeks of GA). For this group, MDI < 70 was observed in 4% of LISA infants vs 21% of intubated infants (P = 0.008).
Conclusion:
At 24 months of age, the LISA-treated infants scored less often PDI < 70 and had similar results in MDI. Infants born at 25 and 26 weeks treated with LISA had lower rates of severe disability. LISA is safe and may be superior.
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