TY - JOUR T1 - Minimally invasive surfactant therapy failure: risk factors and outcome JF - Archives of Disease in Childhood - Fetal and Neonatal Edition JO - Arch Dis Child Fetal Neonatal Ed SP - F636 LP - F642 DO - 10.1136/archdischild-2018-316258 VL - 104 IS - 6 AU - Lobke CE Janssen AU - Jooske Van Der Spil AU - Anton H van Kaam AU - Jeanne P Dieleman AU - Peter Andriessen AU - Wes Onland AU - Hendrik J Niemarkt Y1 - 2019/11/01 UR - http://fn.bmj.com/content/104/6/F636.abstract N2 - 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. ER -