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Less invasive surfactant administration (LISA) is a method to deliver surfactant to spontaneously breathing premature infants via a thin catheter. Here we report the two-year outcome from the AMV (avoid mechanical ventilation) study, the first randomized controlled trial on this mode of surfactant delivery. No statistically significant differences in weight, length or neurodevelopmental outcome (Bayley II scores) were found between the LISA intervention group (n = 95) and the control group (n = 84) that received standard treatment.Conclusion: No differences in outcome were observed at 2 years. LISA seems safe in that aspect. What is Known:• LISA is a method that is in increasing use for surfactant delivery to spontaneously breathing infants. LISA reduces the need for mechanical ventilation. What is New:• Outcome data at 2 years from the first randomized study with LISA raise no safety concerns in comparison to a group of infants that received standard treatment.

Zusammenfassung Ziel Die Prävention der Hypothermie ist eine der wichtigsten Maßnahmen bei der Erstversorgung kleiner Frühgeborener. Es existiert eine umfassende Datenlage zu diversen Präventionsmaßnahmen (z. B. Anwärmen der Atemluft, sterile Folien, Wärmestrahler, Gelmatratzen etc.), jedoch gibt es bislang keine Empfehlungen bzw. Vergleichsstudien zu dem Teilaspekt der optimalen Raumtemperatur im Erstversorgungsraum. Methoden Vergleich der rektalen Aufnahmetemperaturen von Frühgeborenen unter 1500 g nach postnataler Versorgung in zwei unterschiedlich warmen Erstversorgungsräumen (28°C vs. 34°C) als retrospektive Kohortenstudie. Ergebnisse Es zeigte sich, dass eine höhere Temperatur im Erstversorgungsraum signifikant weniger hypotherme Frühgeborene (Aufnahmetemperatur 37,5°C zur Folge hatte. Fazit Die Auskühlung von Frühgeborenen könnte durch eine höhere Temperatur im Erstversorgungsraum mit verhindert werden. Weitere Studien sollten diesen Teilaspekt untermauern, wodurch eventuell eine Aussage zur optimalen Temperatur im Erstversorgungsraum gegeben werden könnte.

Surfactant is usually given to mechanically ventilated preterm infants via an endotracheal tube to treat respiratory distress syndrome. We tested a new method of surfactant application to spontaneously breathing preterm infants to avoid mechanical ventilation.In a parallel-group, randomised controlled trial, 220 preterm infants with a gestational age between 26 and 28 weeks and a birthweight less than 1·5 kg were enrolled in 12 German neonatal intensive care units. Infants were independently randomised in a 1:1 ratio with variable block sizes, to standard treatment or intervention, and randomisation was stratified according to centre and multiple birth status. Masking was not possible. Infants were stabilised with continuous positive airway pressure and received rescue intubation if necessary. In the intervention group, infants received surfactant treatment during spontaneous breathing via a thin catheter inserted into the trachea by laryngoscopy if they needed a fraction of inspired oxygen more than 0·30. The primary endpoint was need for any mechanical ventilation, or being not ventilated but having a partial pressure of carbon dioxide more than 65 mm Hg (8·6 kPa) or a fraction of inspired oxygen more than 0·60, or both, for more than 2 h between 25 h and 72 h of age. Analysis was by intention to treat. This study is registered, number ISRCTN05025922.108 infants were assigned to the intervention group and 112 infants to the standard treatment group. All infants were analysed. On day 2 or 3 after birth, 30 (28%) infants in the intervention group were mechanically ventilated versus 51 (46%) in the standard treatment group (number needed to treat 6, 95% CI 3-20, absolute risk reduction 0·18, 95% CI 0·30-0·05, p=0·008). 36 (33%) infants in the intervention group were mechanically ventilated during their stay in the hospital compared with 82 (73%) in the standard treatment group (number needed to treat: 3, 95% CI 2-4, p0·0001). The intervention group had significantly fewer median days on mechanical ventilation, (0 days. IQR 0-3 vs 2 days, 0-5) and a lower need for oxygen therapy at 28 days (30 infants [30%] vs 49 infants [45%], p=0·032) compared with the standard treatment group. We recorded no differences between groups for mortality (seven deaths in the intervention group vs five in the standard treatment group) and serious adverse events (21 vs 28).The application of surfactant via a thin catheter to spontaneously breathing preterm infants receiving continuous positive airway pressure reduces the need for mechanical ventilation.German Ministry of Research and Technology, University of Lübeck, and Chiesi Pharmaceuticals.

Objective Preterm infants are at risk of acquiring human cytomegalovirus (CMV) infection through breast milk transmission, possibly leading to serious symptoms, as suggested by previous studies. Over a period of 8.5 years, we compared infants infected postnatally with CMV with noninfected controls to determine whether CMV infection transmitted through breast milk poses serious acute risks. Study design CMV monitoring included maternal serologic testing and biweekly viral culture and polymerase chain reaction in breast milk and infant urine. Clinical and laboratory test findings were assessed retrospectively in infected infants and controls matched for gestational age during the initial hospital stay. Results Forty CMV-infected infants met the study criteria. They had lower minimal platelet and neutrophil counts and a higher frequency of C-reactive protein (CRP) elevations to 10 to 20 mg/L than their matched controls ( P ≤ .001). But no association of CMV infection with bronchopulmonary dysplasia, necrotizing enterocolitis, growth, or CRP elevations to > 20 mg/L was found. Cholestasis appeared in 3 infants in the CMV-infected group, but disappeared within 10 weeks. Conclusions Neonatal symptoms related to postnatal CMV infection were transient and had no affect on neonatal outcome in these infants, in contrast with uncontrolled reports. Whether withholding or pasteurizing breast milk is warranted, however, depends on long-term outcome.

Background: After elimination of CMV transmission by blood products we have still observed preterm infants with postnatally acquired CMV infections. 16 preterm infants with CMV infection by breast milk were identified. Methods: CMV-DNA PCR and viral cultures. Criteria of transmission: CMV in breast milk; viruria in preterm infants; exclusions of congenital infection, of donor's breast milk and of CMV seropositive blood transfusions. Results: 8 infants (50 %) had marked symptoms of an acute CMV infection: sepsis-like symptoms with apnoea and bradycardia (4), cholestasis/hepatitis (4/2), thrombocytopenia (6), neutropenia (5). Infection in the latter group occurred at an median postnatal age of 46 vs. 62 days in asymptomatic infected infants (p < 0.01). Conclusion: There is a high incidence of symptomatic CMV infections in preterm infants due to breast milk transmission. An early postnatal CMV infection seems to be associated with a symptomatic clinical course.