Frontiers in pediatrics · 2026
Minimally invasive surfactant administration in extremely preterm infants <28 weeks gestation with spontaneous breathing: a retrospective quality improvement study on reducing invasive ventilation burden.
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Dong Wenxin, Zhang Hui, Li Xinyue, Zhang Hua, Li Zailing, Han Tongyan
Аннотация
BACKGROUND: Invasive surfactant delivery via endotracheal intubation increases exposure to invasive mechanical ventilation (IMV) in extremely preterm infants (EPIs, <28 weeks). This quality improvement (QI) initiative aimed to evaluate whether minimally invasive surfactant administration (MISA) was associated with a reduced IMV burden in EPIs.
METHODS: A single-center retrospective QI study (2013-2024) included 115 infants (24-27⁺⁶ weeks) with spontaneous breathing diagnosed with respiratory distress syndrome (RDS). Controls (2013-2019, n = 55) received surfactant via intubation; the MISA group (2020-2024, n = 60) received surfactant via thin catheter during nasal continuous positive airway pressure/nasal intermittent positive pressure ventilation (NCPAP/NIPPV). Apart from the structured implementation of MISA, background respiratory and supportive care practices evolved gradually over time without other major structural changes. Multivariable regression and interrupted time-series analyses were performed to account for potential confounding and secular trends.
RESULTS: Baseline infant characteristics were comparable. The median duration of IMV within the first 72 h after birth was 0 h (IQR: 0-0) in the MISA group compared to 71.0 h (IQR: 19.0-72.0) in the control group (P < 0.001), and the difference remained significant after adjustment. Additionally, total IMV duration was reduced [0 h (IQR: 0-14) vs. 111 h (IQR: 39-264); P < 0.001], while non-invasive ventilation (NIV) duration was longer [51.5d (IQR: 41-57) vs. 37d (IQR 30-50); P < 0.001]. Lower incidences of hemodynamically significant patent ductus arteriosus (hsPDA) (35.0% vs. 69.1%; P < 0.001) and nosocomial pneumonia (18.9% vs. 67.9%; P < 0.001) were observed during the MISA implementation period, with consistent findings after multivariable adjustment. No significant differences were observed in severe intraventricular hemorrhage (IVH grade 3-4) (8.33% vs. 20.4%; P = 0.123), mortality (6.7% vs. 16.4%; P = 0.101), or other secondary outcomes (all P > 0.05). Interrupted time-series analysis demonstrated an immediate reduction in early IMV duration following MISA implementation, whereas changes in secondary outcomes did not reach statistical significance.
CONCLUSION: MISA was associated with reduced early and overall IMV exposure in EPIs <28 weeks, and with lower observed incidences of hsPDA and nosocomial pneumonia. These associations warrant confirmation in prospective multicenter studies.
METHODS: A single-center retrospective QI study (2013-2024) included 115 infants (24-27⁺⁶ weeks) with spontaneous breathing diagnosed with respiratory distress syndrome (RDS). Controls (2013-2019, n = 55) received surfactant via intubation; the MISA group (2020-2024, n = 60) received surfactant via thin catheter during nasal continuous positive airway pressure/nasal intermittent positive pressure ventilation (NCPAP/NIPPV). Apart from the structured implementation of MISA, background respiratory and supportive care practices evolved gradually over time without other major structural changes. Multivariable regression and interrupted time-series analyses were performed to account for potential confounding and secular trends.
RESULTS: Baseline infant characteristics were comparable. The median duration of IMV within the first 72 h after birth was 0 h (IQR: 0-0) in the MISA group compared to 71.0 h (IQR: 19.0-72.0) in the control group (P < 0.001), and the difference remained significant after adjustment. Additionally, total IMV duration was reduced [0 h (IQR: 0-14) vs. 111 h (IQR: 39-264); P < 0.001], while non-invasive ventilation (NIV) duration was longer [51.5d (IQR: 41-57) vs. 37d (IQR 30-50); P < 0.001]. Lower incidences of hemodynamically significant patent ductus arteriosus (hsPDA) (35.0% vs. 69.1%; P < 0.001) and nosocomial pneumonia (18.9% vs. 67.9%; P < 0.001) were observed during the MISA implementation period, with consistent findings after multivariable adjustment. No significant differences were observed in severe intraventricular hemorrhage (IVH grade 3-4) (8.33% vs. 20.4%; P = 0.123), mortality (6.7% vs. 16.4%; P = 0.101), or other secondary outcomes (all P > 0.05). Interrupted time-series analysis demonstrated an immediate reduction in early IMV duration following MISA implementation, whereas changes in secondary outcomes did not reach statistical significance.
CONCLUSION: MISA was associated with reduced early and overall IMV exposure in EPIs <28 weeks, and with lower observed incidences of hsPDA and nosocomial pneumonia. These associations warrant confirmation in prospective multicenter studies.