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Two-Year Outcomes of Less Invasive Surfactant Administration Among Preterm Neonates: A Secondary Analysis of a
Rebecca A Dorner1, Ana Morales1, Anamika Banerji2
1Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California.
JAMA Network Open
|March 31, 2026
Summary
Early caffeine and less invasive surfactant administration (LISA) in preterm neonates did not reduce death or neurodevelopmental impairment by age 2. However, LISA did improve fine motor skills, suggesting potential benefits for preterm infant development.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Respiratory Care
Background:
- Continuous positive airway pressure (CPAP) is a common respiratory support for preterm neonates.
- Early caffeine and less invasive surfactant administration (LISA) reduce endotracheal intubation rates.
- Long-term neurodevelopmental and pulmonary outcomes of this combined regimen are not well-established.
Purpose of the Study:
- To evaluate the efficacy of early caffeine and LISA in improving neurodevelopmental impairment (NDI) and pulmonary outcomes at 2 years corrected age in preterm infants.
- To assess the impact of LISA on neurodevelopmental trajectories and respiratory health in a vulnerable preterm population.
Main Methods:
- A secondary analysis of a randomized clinical trial involving preterm infants (24-29 weeks gestational age) receiving either LISA or CPAP with early caffeine.
- Neurodevelopmental outcomes were assessed at 2 years corrected age using the Bayley Scales of Infant Development (BSID) and Ages and Stages Questionnaire (ASQ-3).
- Pulmonary outcomes included bronchodilator use, corticosteroid use, and respiratory-related hospitalizations.
Main Results:
- No significant difference was found in the composite outcome of death or moderate to severe NDI between the LISA and CPAP groups (23.0% vs 32.9%).
- Infants in the LISA group showed a statistically significant improvement in the fine motor domain z-score on the ASQ-3.
- There were no significant differences in overall developmental typicality or rates of possible delay between the groups, nor in pulmonary outcomes.
Conclusions:
- Early caffeine administration combined with LISA does not significantly reduce the incidence of death or moderate to severe neurodevelopmental impairment in preterm infants by 2 years corrected age.
- The LISA regimen may be associated with improved fine motor development in preterm infants.
- Further research is needed to fully elucidate the long-term benefits and potential risks of LISA in preterm neonates.
