Association of Administration of Surfactant Using Less Invasive Methods With Outcomes in Extremely Preterm Infants Less Than 27 Weeks of Gestation

Härtel C, Herting E, Humberg A, Hanke K, Mehler K, Keller T, Mauer I, Frieauff E, Meyer S, Thome UH, Wieg C, Schmidtke S, Kribs A, Göpel W, Faust K, Müller D, Gebauer C, Guthmann F, von der Wense A, Stangl O, Weller U, Höhn T, Olbertz D, Felderhoff-Müser U, Rossi R, Teig N, Heitmann F, Heckmann M, Laux R, Bohnhorst B, Roth B, Vochem M, Keller-Wackerbauer A, Möller J, Eichhorn J, Wintgens J, Böttger R, Reese J, Hubert M, Dördelmann M, Hillebrand G, Roll C, Jensen R, Rüdiger M, Werner C, Longardt AC, Schäfer S, Schaible T, Franz A, Heldmann M, Kunzmann S, Schmidt E, Orlikowsky T, Gerleve H, Depping N, Haase R, Hoppenz M, Seeliger S, Küster H, Fuchs H, Körner T, Brune T, Müller A, Urlichs F, Berghäuser M, Proquitté H, Morhart P, Lindner W, Schlösser R, Schneider W, Schroth M, Rieger-Fackeldey E, Dohle F, Sinnecker G, Völkl T, Nunez FB, Welsch M, Krüger M (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Book Volume: 5

Article Number: e2225810

Journal Issue: 8

DOI: 10.1001/jamanetworkopen.2022.25810

Abstract

Importance: The inclusion of less invasive surfactant administration (LISA) in the care of preterm infants has been found to be beneficial for respiratory outcomes. Recently, the OPTIMIST trial found higher mortality rates in the subgroup of infants born at 25 to 26 weeks' gestational age (GA) who received surfactant treatment while spontaneously breathing. Objective: To analyze outcomes among LISA-exposed, highly vulnerable babies born at less than 27 weeks' GA within the large-scale observational cohort of the German Neonatal Network. Design, Setting, and Participants: In this cohort study of data from 68 tertiary level neonatal intensive care units in Germany of infants born between 22 weeks 0 days to 26 weeks 6 days of gestation between April 1, 2009, and December 31, 2020, short-term outcomes among infants receiving LISA vs infants not receiving LISA were compared. Exposure: Use of LISA within the first 72 hours of life. Main Outcomes and Measures: The main outcomes were rates of LISA use, use of mechanical ventilation within the first 72 hours (considered failure of LISA), and association of LISA with outcomes, including death from all causes, bronchopulmonary dysplasia (BPD), death and BPD combined, pneumothorax, retinopathy of prematurity, intracerebral hemorrhage, and periventricular leukomalacia. To address potential confounding factors, multivariate logistic regression models were used. Results: A total of 6542 infants (3030 [46.3%] female and 3512 [53.7%] male; mean [SD] GA, 25.3 (1.1) weeks; mean [SD] birth weight, 715 [180] g) were analyzed; 2534 infants (38.7%) received LISA, which was most frequently given quasi-prophylactically during delivery room management. Among the infants who received LISA, 1357 (53.6%) did not require mechanical ventilation in the first 72 hours compared with 331 infants (8.3%) of 4008 who did not receive LISA. In a multivariate logistic regression model that adjusted for GA, small-for-GA status, sex, multiple birth, inborn status, antenatal steroid use, and maximum fraction of inspired oxygen in the first 12 hours of life, LISA was associated with reduced risks of all-cause death (odds ratio [OR], 0.74; 95% CI, 0.61-0.90; P =.002), BPD (OR, 0.69; 95% CI, 0.62-0.78; P <.001), and BPD or death (OR, 0.64; 95% CI, 0.57-0.72; P <.001) compared with infants without LISA exposure. Conclusions and Relevance: The results of this long-term multicenter cohort study suggest that LISA may be associated with reduced risks of adverse outcomes in extremely preterm infants.

Involved external institutions

Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Universität zu Köln Germany (DE) Heinrich-Heine-Universität Düsseldorf Germany (DE) Diakonissenkrankenhaus Flensburg Germany (DE) Klinikum Itzehoe Germany (DE) Universität Witten/Herdecke Germany (DE) Georg-August-Universität Göttingen Germany (DE) Klinikum Links der Weser Germany (DE) Julius-Maximilians-Universität Würzburg Germany (DE) Universitätsklinikum des Saarlandes (UKS) Germany (DE) Universitätsklinikum Leipzig Germany (DE) Klinikum Aschaffenburg-Alzenau Germany (DE) Asklepios Klinik Barmbek Germany (DE) Gemeinschaftsklinikum Mittelrhein Germany (DE) Klinikum Kassel GmbH Germany (DE) Kinder- und Jugendkrankenhaus Auf der Bult Germany (DE) Altonaer Kinderkrankenhaus (AKK) Germany (DE) Evangelisches Klinikum Bethel Germany (DE) Klinikum Südstadt Rostock Germany (DE) Universitätsklinikum Essen Germany (DE) Vivantes - Netzwerk für Gesundheit GmbH Germany (DE) Katholisches Klinikum Bochum (St. Josef- und St. Elisabeth-Hospital gGmbH) Germany (DE) Klinikum Dortmund Germany (DE) Universität Greifswald Germany (DE) Asklepios Kliniken Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Universitätsklinikum Köln Germany (DE) Klinikum Stuttgart Germany (DE) Barmherzige Brüder Klinik St. Hedwig Regensburg Germany (DE) Klinikum Leverkusen Germany (DE) Städtische Kliniken Mönchengladbach GmbH / Elisabeth-Krankenhaus Rheydt Germany (DE) Universitätsklinikum Magdeburg A.ö.R. Germany (DE) Sana Kliniken Ostholstein Germany (DE) DRK-Kinderklinik Siegen Germany (DE) Westküstenkliniken Brunsbüttel und Heide gGmbH Germany (DE) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Westfälische Wilhelms-Universität (WWU) Münster Germany (DE) Klinikum Nürnberg Germany (DE) Universitätsklinikum Tübingen Germany (DE) HELIOS Kliniken Germany (DE) Bürger­hospital Frankfurt Germany (DE) Universitätsklinikum Aachen (UKA) Germany (DE) GFO Kliniken Bonn Germany (DE) Universitätsklinikum Halle (Saale) Germany (DE) Kliniken der Stadt Köln Germany (DE) Universitätsklinikum Freiburg Germany (DE) Klinikum Lippe Germany (DE) Universitätsklinikum Bonn Germany (DE) St. Franziskus-Hospital Münster Germany (DE) Florence Nightingale Hospital / Florence-Nightingale-Krankenhaus Germany (DE) Universitätsklinikum Jena Germany (DE) Universitätsklinikum Ulm Germany (DE) Universitätsklinikum Frankfurt am Main (KGU) Germany (DE) Klinikum rechts der Isar Germany (DE) St. Vincenz-Kliniken GmbH Germany (DE) Klinikum Wolfsburg Germany (DE) Josefinum Augsburg Germany (DE) Sana Kliniken AG Germany (DE) Cnopf'sche Kinderklinik Germany (DE) DONAUISAR Klinikum Deggendorf-Dingolfing-Landau Germany (DE) München Klinik gGmbH Germany (DE)

How to cite

APA:

Härtel, C., Herting, E., Humberg, A., Hanke, K., Mehler, K., Keller, T.,... Krüger, M. (2022). Association of Administration of Surfactant Using Less Invasive Methods With Outcomes in Extremely Preterm Infants Less Than 27 Weeks of Gestation. JAMA Network Open, 5(8). https://doi.org/10.1001/jamanetworkopen.2022.25810

MLA:

Härtel, Christoph, et al. "Association of Administration of Surfactant Using Less Invasive Methods With Outcomes in Extremely Preterm Infants Less Than 27 Weeks of Gestation." JAMA Network Open 5.8 (2022).

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