TOP 62 - Incidence of intraventricular hemorrhage based on surfactant administration technique in 30 to 36 weeks preterm infants

Publication Number: 4766.TOP 62

Syed Mujtaba Azhar Bokhari, University of South Alabama Children's and Women's Hospital, Mobile, AL, United States; Gangajal Kasniya, University of South Alabama Children's and Women's Hospital, Mobile, AL, United States; Saminathan Anbalagan, University of South Alabama Children's and Women's Hospital, Mobile, AL, United States

Background: The Less Invasive Surfactant Administration (LISA) technique is increasingly adopted in the United States for treating respiratory distress syndrome (RDS), especially among moderate to late preterm (MLPT) infants. Most randomized controlled trials on LISA, however, have focused on extremely and very preterm populations. Several of these studies have reported reduced rates of intraventricular hemorrhage (IVH) with the use of LISA. Although IVH incidence declines sharply beyond 30 weeks’ gestation, critically ill infants—particularly those requiring surfactant—remain at risk. Evidence describing IVH outcomes in this group is limited, and the potential impact of LISA on IVH among MLPT infants remains poorly defined (Silveira, 2024).

Objective: To compare the incidence of IVH in moderate to late preterm infants (≥30 weeks’ gestation) treated with surfactant for RDS via the catheter-based LISA technique versus the Intubation–Surfactant–Extubation (INSURE) method.

Design/Methods: This retrospective chart review included infants born at ≥30 weeks’ gestation and admitted to the USA Children’s & Women’s Hospital Level IIIb NICU in Mobile, Alabama, between 2020 and 2025. Institutional Review Board approval with consent deferral was obtained. Infants who received surfactant for RDS using either the LISA or INSURE method were included (n = 292) and categorized by the administration technique. Those with prenatally diagnosed major congenital anomalies were excluded.

Collected data included gestational age (GA), birth weight (BW), small-for-gestational-age (SGA) status, delivery mode, sex, race, antenatal steroids and magnesium use, umbilical cord gas values, 5- and 10-minute Apgar scores, maximum FiO2 within 48 hours of life, early blood gas and complete blood count results (within 6 hours), blood culture results, timing and number of surfactant doses, and head ultrasound findings within the first 10 days of life. IVH will be classified based on Papile’s grading system. Premedication for surfactant administration was not routinely performed (institutional practice).

Categorical and continuous variables will be analyzed using the chi-square test and t-test, or the Mann–Whitney U test, as appropriate. Logistic regression will be performed to assess differences in IVH incidence between groups after adjusting for potential confounders, including GA, BW, SGA status, sex, antenatal steroid exposure, low Apgar scores, anemia, acidosis, FiO2 requirements, bacteremia, and number of surfactant doses.