Clinical summaries in neonatology:
key insights into leading publications
Welcome to our clinical summaries page, where we present essential topics in neonatology through clear, concise overviews of key publications.
- These summaries distil critical findings and best practices from leading studies, offering accessible insights into core areas of neonatal care.
- Created to support informed decisions and current clinical knowledge, these summaries offer a streamlined path to the latest evidence and advancements in neonatal care.
To explore our summaries, simply select a key topic from the tabs below. Each tab will guide you to a selection of curated summaries focused on that area.
LISA summaries:
Changes in practice of less-invasive surfactant administration (LISA) in United Kingdom neonatal units (2024)
Sandeep Shetty, Donna Tolentino, Cheryl Lau, Donovan Duffy, Anne Greenough
This study tracks the significant rise in LISA across every UK neonatal unit, with usage rising from 19% in 2018 to 70% in 2024. Despite this progress, challenges like training gaps and logistical barriers still limit wider adoption.
Read how these findings spotlight a shift toward less-invasive neonatal respiratory care, underscoring the need for standardised training and protocols to fully realise LISA’s benefits for preterm infants.
Surfactant therapy via thin catheter in preterm infants with or at risk of respiratory distress syndrome (Review) (2021)
Abdel-Latif ME, Davis PG, Wheeler KI, De Paoli AG, Dargaville PA
This Cochrane review assessed the effectiveness of surfactant administration via LISA compared with traditional endotracheal intubation for preterm infants with RDS. Drawing on data from 16 randomised trials with over 2,100 preterm infants, the review found that LISA significantly reduced the risk of death or BPD, need for intubation, and severe complications compared with surfactant administration via endotracheal tube.
Read more to see how these findings support LISA as a more effective, less-invasive approach for surfactant delivery in neonatal respiratory care, highlighting its positioning as a new standard of care.
Effect of Minimally Invasive Surfactant Therapy vs Sham Treatment on Death or Bronchopulmonary Dysplasia in Preterm Infants With Respiratory Distress Syndrome — The OPTIMIST-A Randomized Clinical Trial (2021)
Dargaville PA, Kamlin OF, Orsini F, Wang X, De Paoli AG, et al.
OPTIMIST-A was a pivotal trial that provided important findings on the use of LISA in 485 preterm infants with RDS who were supported on continuous positive airway pressure (CPAP) and had an FiO2 ≥0.3. While LISA did not significantly affect the combined rates of death or BPD, it notably reduced BPD among survivors and decreased the need for intubation within the first 72 hours of life.
Read more about how this study positioned LISA as a technique for helping to mitigate respiratory complications in neonatal care.
Early intervention summaries:
Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial (2011)
Göpel W, Kribs A, Ziegler A, Laux R, Hoehn T, et al.
The AMV trial explored the impact of early intervention with surfactant administration via LISA for spontaneously breathing preterm infants on CPAP. This proactive approach, tested across 12 German NICUs, demonstrated that delivering surfactant early and without mechanical ventilation significantly reduced the need for later intubation, shortened ventilation times, and lowered oxygen dependency at 28 days compared with standard treatment.
These findings highlight the benefits of early, minimally invasive surfactant therapy as an effective strategy to prevent respiratory complications in neonatal care — read on for a detailed summary of this important study.
Continuous positive airway pressure failure in preterm infants: incidence, predictors and consequences (2013)
Dargaville PA, Aiyappan A, De Paoli AG, Dalton RGB, et al.
This pivotal study examined CPAP failure in preterm infants with RDS, identifying low gestational age (GA) and high oxygen requirements as primary predictors. Infants who failed CPAP faced significantly higher rates of BPD, pneumothorax, and prolonged respiratory support compared with those who successfully maintained CPAP.
Read about how this study underscored the critical importance of early intervention in improving respiratory outcomes and helped inform the FiO₂ thresholds that are now established in European guidelines.
Fraction of Inspired Oxygen as a Predictor of CPAP Failure in Preterm Infants with Respiratory Distress Syndrome: A Prospective Multicenter Study (2019)
Gulczyńska E, Szczapa T, Hożejowski R , Borszewska-Kornacka MK, Rutkowska M.
This study underscored the importance of CPAP success in preterm infants with RDS and identified key factors that influenced clinical outcomes. Low GA, low birth weight and an FiO₂ threshold exceeding 0.29 in the second hour of life were significant predictors of CPAP failure, with infants above this oxygen requirement facing higher risks of complications such as BPD and pneumothorax, as well as an increased likelihood of requiring mechanical ventilation.
Discover how this study has helped shaped guideline recommendations, supporting standardised approaches to enhance CPAP success and improve outcomes in neonatal care.
Incidence and Outcome of CPAP Failure in Preterm Infants (2016)
Dargaville PA, Gerber A, Johansson S, De Paoli AG, , et al.
This study emphasised the crucial role of early intervention in ensuring CPAP success for preterm infants with RDS. It identified CPAP failure as relatively common, especially in infants less than 29 weeks GA, with key risk factors including low birth weight, incomplete antenatal steroid exposure, and Caesarean delivery without labour. CPAP failure was closely linked to adverse outcomes, including higher rates of pneumothorax, BPD, and longer hospital stays.
Read about how these findings highlighted the importance of early, proactive strategies to prevent CPAP failure, contributing to the development of guidelines that reinforce early intervention as essential for managing preterm infants on CPAP.
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Abbreviations
BPD, bronchopulmonary dysplasia; CPAP, continuous positive airway pressure; FiO₂, fraction of inspired oxygen; GA, gestational age; INSURE, intubation-surfactant-extubation; LISA, less-invasive surfactant administration; NICU, neonatal intensive care unit; RDS, respiratory distress syndrome.
References
- Shetty S, et al. Changes in practice of less-invasive surfactant administration (LISA) in United Kingdom neonatal units. Acta Paediatr. 2024:doi: 10.1111/apa.17446
- Silveira RC, et al. Less invasive surfactant administration versus intubation-surfactant-extubation in the treatment of neonatal respiratory distress syndrome: a systematic review and meta-analyses. J Pediatr (Rio J). 2024;100(1):8–24.
- Abdel-Latif ME, et al. Surfactant therapy via thin catheter in preterm infants with or at risk of respiratory distress syndrome. Cochrane Database of Systematic Reviews 2021;5:DOI: 10.1002/14651858.CD011672.pub2
- Dargaville PA, et al. Effect of Minimally Invasive Surfactant Therapy vs Sham Treatment on Death or Bronchopulmonary Dysplasia in Preterm Infants With Respiratory Distress Syndrome: The OPTIMIST-A Randomized Clinical Trial. JAMA. 2021;326(24):2478–2487.
- Göpel W, et al. Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. Lancet. 2011;378(9803):1627–34
- Dargaville PA, et al. Continuous positive airway pressure failure in preterm infants: incidence, predictors and consequences. Neonatology. 2013;104(1):8–14
- Gulczyńska E, et al. Fraction of Inspired Oxygen as a Predictor of CPAP Failure in Preterm Infants with Respiratory Distress Syndrome: A Prospective Multicenter Study. Neonatology. 2019;116(2):171–178
- Dargaville PA, et al. Incidence and Outcome of CPAP Failure in Preterm Infants. Pediatrics. 2016 Jul;138(1):e20153985
IE-NEO-2400258 | December 2024
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