LISA failure and school-age motor impairment in very preterm infants: a retrospective cohort study
In brief
In very preterm infants, surfactant failure linked to lower motor scores at 5.5
In this retrospective study, 32% of infants given less-invasive surfactant administration needed mechanical ventilation within 72 hours. This failure was associated with lower motor scores at age 5.5, but not with cognitive outcomes; follow-up covered only 68% of survivors, so the long-term finding needs confirmation.
- Journal
- Neonatology (Q1)
- Published
- 16 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Sascha Portheine, Floor Pm Swinkels, Brigit Vugs, Jeanne P Dieleman, Carola van Pul, Peter Andriessen, et al.
- PMID
- 42886624
- DOI
- 10.1159/neo/adsag031
Why clinicians should know about it
- Picked for Neonatology (paper of the day, 18 October 2026): LISA failure linked to school‑age motor outcomes
Abstract
Background Less invasive surfactant administration (LISA) reduces the need for early invasive mechanical ventilation in preterm infants with respiratory distress syndrome. However, LISA failure (LISA-F), defined as the need for mechanical ventilation within 72 hours of life, occurs in a substantial proportion of cases. While the short-term complications of LISA-F are well described, the impact on long-term neurodevelopment remains unclear. Methods This retrospective cohort study included preterm infants born between 24+0 and 29+6 weeks' gestation who received surfactant therapy in a tertiary neonatal intensive care unit. Infants were classified into three groups: LISA success (LISA-S), LISA-F, or primary intubation (PI). Neurodevelopmental outcomes were assessed at 5.5 years of age using WPPSI-IV-NL for cognition and mABC-2 for motor function. Multivariate analyses were adjusted for gestational age, birth weight z-score, antenatal corticosteroid exposure and severe intraventricular hemorrhage. Results Among 295 infants, 225 (76.3%) received LISA; 32% experienced LISA-F. Follow-up data were available for 168 of 246 survivors (68.3%). LISA-F was independently associated with lower motor scores than LISA-S (adjusted β -2.1; p=0.004), but not with cognitive outcomes. Infants who underwent primary intubation had significantly lower cognitive scores than those in the LISA-S group (adjusted β -5.1; p=0.038). Invasive mechanical ventilation within the first 72 hours was independently associated with motor developmental delay (aOR:3.9; 95% CI 1.2-13.2; p=0.028) Conclusion LISA-F is associated with adverse motor outcomes at school age. Our findings suggest that the early respiratory trajectory after LISA is more relevant to long term motor development than the initial surfactant administration technique itself.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.