Résumé
Less invasive surfactant administration (LISA) may reduce the need for invasive ventilation and decrease the risk of mortality and bronchopulmonary dysplasia (BPD). Few studies have documented the influence of this procedure on the rate of surfactant use in preterm neonates.Methods: the primary objective was to compare the rate of surfactant therapy for preterm neonates over two distinct periods of 3 years (2013-2015 and 2019-2021), before and after the implementation of a protocol for LISA (2017). The secondary objective was to compare respiratory and overall management between these two periods.Results: 1,781 neonates [32.6 (30-34) wGA, 1,600 (1,210-2,000) g] were included, 9% at 23-26 wGA, 46% at 27-32 wGA and 45% at 33-36 wGA. LISA became the standard method (76% vs 0.4%, p<0.001), for all gestational ages. Surfactant use decreased (33% vs 40%, p<0.01), especially at 28-29 wGA (57,9% vs 76,7%, p<0.01). Sedation rate remained stable (84%). More children required a second dose (19% vs 12%, p<0.001). The use of invasive ventilation decreased (12% vs 31%, p<0.001) but the BPD rate increased in the 27-32 wGA subgroup (15% vs 8.5%, p<0.01). Conclusion: LISA has become the standard method for surfactant administration for all preterm infants, with a reduction in the use of surfactant and invasive ventilation, without demonstrating a benefit on BPD risk.