Neonatal Outcomes of the Intubation-Surfactant-Extubation versus Less Invasive Surfactant Administration Method: A National Cohort Study in Korea.

Introduction: This study aimed to compare the outcomes of intubation-surfactant-extubation (INSURE) and less invasive surfactant administration (LISA) in very preterm infants with respiratory distress syndrome.

Methods: This study included preterm infants born in South Korea at <32 weeks' gestation and registered in the Korean Neonatal Network database between January 2019 and December 2022. We analyzed and compared the ventilator support duration, mortality, and major morbidities before discharge from the neonatal intensive care unit treated with INSURE and LISA methods.

Results: A total of 1,112 infants who received surfactants via INSURE (n = 627) or LISA (n = 485) were included. No significant intergroup differences were observed in the duration of invasive ventilation, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, or mortality. However, infants in the LISA group had a lower risk of severe BPD (adjusted odds ratio [aOR], 0.514; 95% confidence interval [CI], 0.346-0.763; p = 0.001), severe BPD or death (aOR, 0.586; 95% CI, 0.402-0.854; p = 0.005), massive pulmonary hemorrhage (aOR, 0.314; 95% CI, 0.122-0.807; p = 0.014), patent ductus arteriosus (aOR, 0.67; 95% CI, 0.497-0.902; p = 0.008), and culture-proven sepsis (aOR, 0.607; 95% CI, 0.411-0.896; p = 0.012) than did those in the INSURE group.

Conclusion: Although LISA did not demonstrate a reduction in either the requirement for respiratory support or its duration compared to INSURE, it was associated with a decrease in severe BPD. These results imply that LISA provides substantial advantages for mitigating severe forms of neonatal morbidities.