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Risk Factors and Prediction Models for Less Invasive Surfactant Administration Failure in Preterm Infants: A
1Department of Neonatology, Institute of Postgraduate Medical education & Research and SSKM Hospital, 244 AJC Bose Road, Kolkata, West Bengal, India.
Pediatric Pulmonology
|May 14, 2025
Summary
Predicting less invasive surfactant administration (LISA) failure in preterm infants with respiratory distress syndrome (RDS) is crucial. Key risk factors include higher oxygen saturation index and incomplete antenatal corticosteroids, informing treatment decisions.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Clinical Informatics
Background:
- Respiratory distress syndrome (RDS) is a common complication in preterm infants.
- Less invasive surfactant administration (LISA) is a preferred method for RDS management.
- Identifying factors predicting LISA failure is essential for optimizing care in low-resource settings.
Purpose of the Study:
- To identify risk factors for LISA failure in preterm infants with RDS in a low-and-middle income country (LMIC).
- To develop and validate prediction models for LISA failure risk.
- To inform clinical decisions regarding surfactant administration strategies.
Main Methods:
- Retrospective cohort study of 600 preterm infants receiving LISA.
- Analysis using random forest, support vector machine, and Lasso penalized logistic regression.
- Validation of prediction models on a testing set.
Main Results:
- LISA failure occurred in 30-40% of infants.
- Significant risk factors included higher oxygen saturation index (OSI), higher cord base deficit, lower birth weight, lower admission temperature, and incomplete antenatal corticosteroids (ANS).
- Random forest and SVM models showed high accuracy (92.42% and 90.91%); Lasso and random forest had high sensitivity (96.55% and 93.88%).
- LISA failure was associated with higher rates of bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and mortality.
Conclusions:
- Prediction models can estimate individual risk of LISA failure.
- Identifying high-risk infants can guide decisions on alternative surfactant administration methods.
- This research has implications for improving outcomes in preterm infants with RDS in LMICs.
