Maiwald Christian A, Franz Axel R, Poets Christian F, Springer Laila
Department of Neonatology, University Children's Hospital Tübingen, Tübingen, Germany.
Center for Pediatric Clinical Studies (CPCS), University Hospital Tübingen, Tübingen, Germany.
Neonatology. 2025;122(1):46-55. doi: 10.1159/000539302. Epub 2024 Jul 17.
The European guideline for treatment of respiratory distress syndrome recommends less invasive surfactant administration (LISA) as the preferred method of surfactant administration in spontaneously breathing preterm infants. However, there is limited evidence on practical aspects such as sedation and catheter types, leading to considerable variability between centers.
An anonymous online survey (
Of 122 (74%) participating NICUs, 117 (96%) reported experience with LISA with 82% of those reporting LISA as their preferred method of surfactant administration. Indications for surfactant administration differed widely between NICUs. Most (89%) used FiO2-thresholds only or in combination with other criteria, such as Silverman score/signs of dyspnea (41%) or lung ultrasound findings (3%). Prophylactic surfactant was administered by 42%. Differences in use of LISA in extremely immature infants were reported (e.g., 36% did not perform LISA in infants below 24-26 weeks). Preferred drugs for sedation were (Es-)Ketamine, followed by Propofol and Midazolam. Minimum time interval between subsequent LISA procedures was 4 (2-6) h. Catheters specifically designed for LISA were used by most NICUs (69%).
This survey shows that LISA is common practice in German NICUs, but with considerable variability in practical aspects. These data may serve as a guidance for NICUs that have not yet implemented LISA and might be helpful design clinical trials with the aim to standardize and/or optimize LISA.
欧洲呼吸窘迫综合征治疗指南推荐在自主呼吸的早产儿中，采用微创表面活性剂给药（LISA）作为表面活性剂给药的首选方法。然而，关于镇静和导管类型等实际操作方面的证据有限，导致各中心之间存在相当大的差异。
向德国164家三级新生儿重症监护病房（NICU）发送了一项匿名在线调查（
在122家（74%）参与调查的NICU中，117家（96%）报告有LISA经验，其中82%将LISA作为表面活性剂给药的首选方法。各NICU在表面活性剂给药指征方面差异很大。大多数（89%）仅使用FiO₂阈值或与其他标准联合使用，如Silverman评分/呼吸困难体征（41%）或肺部超声检查结果（3%）。42%的NICU给予预防性表面活性剂。报告了在极不成熟婴儿中使用LISA的差异（例如，36%在24 - 26周以下的婴儿中未进行LISA）。首选的镇静药物是（依托）氯胺酮，其次是丙泊酚和咪达唑仑。后续LISA操作之间的最短时间间隔为4（2 - 6）小时。大多数NICU（69%）使用专门为LISA设计的导管。
本次调查表明，LISA在德国NICU中是常见的做法，但在实际操作方面存在相当大的差异。这些数据可为尚未实施LISA的NICU提供指导，并可能有助于设计旨在规范和/或优化LISA的临床试验。
