Table_2_FiO2 Before Surfactant, but Not Time to Surfactant, Affects Outcomes in Infants With Respiratory Distress Syndrome.pdf

Aim: To establish the impact of oxygen requirement before surfactant (SF) and time from birth to SF administration on treatment outcomes in neonatal respiratory distress syndrome (RDS). Methods: We conducted a post-hoc analysis of data from a prospective cohort study of 500 premature infants treated with less invasive surfactant administration (LISA). LISA failure was defined as the need for early (<72 h of life) mechanical ventilation (MV). Baseline clinical characteristic parameters, time to SF, and fraction of inspired oxygen (FiO 2 ) prior to SF were all included in the multifactorial logistic regression model that explained LISA failure. Results: LISA failed in 114 of 500 infants (22.8%). The median time to SF was 2.1 h (IQR: 0.8–6.7), and the median FiO 2 prior to SF was 0.40 (IQR: 0.35–0.50). Factors significantly associated with LISA failure were FiO 2 prior to SF (OR 1.03, 95% CI 1.01–1.04) and gestational age (OR 0.82, 95 CI 0.75–0.89); both p <0.001. Time to SF was not an independent risk factor for therapy failure (p = 0.528) or the need for MV at any time during hospitalization (p = 0.933). Conclusions: The FiO 2 before SF, but not time to SF, influences the need for MV in infants with RDS. While our findings support the relevance of FiO 2 in SF prescription, better adherence to the recommended FiO 2 threshold for SF (0.30) is required in daily practice.