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Minimally invasive surfactant therapy failure: risk factors and outcome
  1. Lobke CE Janssen1,2,
  2. Jooske Van Der Spil3,
  3. Anton H van Kaam3,
  4. Jeanne P Dieleman4,
  5. Peter Andriessen2,
  6. Wes Onland3,
  7. Hendrik J Niemarkt2
  1. 1 Faculty of Medicine, Maastricht University, Maastricht, The Netherlands
  2. 2 Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
  3. 3 Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, Amsterdam, The Netherlands
  4. 4 MMC Academy, Máxima Medical Centre, Veldhoven, The Netherlands
  1. Correspondence to Dr. Hendrik J Niemarkt, Máxima Medical Center; hendrik.niemarkt{at}


Objective To evaluate incidence of minimally invasive surfactant therapy (MIST) failure, identify risk factors and assess the impact of MIST failure on neonatal outcome.

Design Retrospective cohort study. MIST failure was defined as need for early mechanical ventilation (<72 hours of life). Multivariate logistic regression analysis was performed to identify risk factors for MIST failure and compare outcomes between groups.

Setting Two tertiary neonatal intensive care centres in the Netherlands.

Patients Infants born between 24 weeks’ and 31 weeks’ gestational age (GA) (n=185) with MIST for respiratory distress syndrome.

Interventions MIST procedure with poractant alfa (100–200 mg/kg).

Main outcome measures Continuous positive airway pressure (CPAP) failure after MIST in the first 72 hours of life.

Results 30% of the infants failed CPAP after MIST. In a multivariate logistic regression analysis, four risk factors were independently associated with failure: GA <28 weeks, C reactive protein ≥10 mg/L, absence of antenatal corticosteroids and lower surfactant dose. Infants receiving 200 mg/kg surfactant had a failure rate of 14% versus 35% with surfactant dose <200 mg/kg. Mean body temperature was 0.4°C lower at neonatal intensive care unit admission and before the procedure in infants with MIST failure.

Furthermore, MIST failure was independently associated with an increased risk of severe intraventricular haemorrhage.

Conclusion We observed moderate MIST failure rates in concordance with the results of earlier studies. Absence of corticosteroids and lower surfactant dose are risk factors for MIST failure that may be modifiable in order to improve MIST success and patient outcome.

  • surfactant
  • preterm
  • respiratory

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  • Contributors LJ: study design, acquisition of data, analysis of data, interpretation of data, wrote first draft manuscript and final approval. JVDS: acquisition of data, analysis of data, input on first draft and final approval. AHvK: study design, analysis and interpretation of data, revision of manuscript and final approval. JD: input on study design, major input on statistical analysis, input on statistical aspects of manuscript and final approval PA: study design, interpretation of data and revision of manuscript final approval. WO: study design, interpretation of data, revision of manuscript and final approval. HN: conceived study, study design, analysis of data, interpretation of data, revision of manuscript and final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The study protocol was approved by the Regional Committee on Medical Research Ethics at Máxima Medical Centre, Veldhoven.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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