Effects of a respiratory care protocol incorporating less invasive surfactant administration in infants born at 30–34 weeks’ gestation

To evaluate the impact of a respiratory care protocol (RCP) including stepwise escalation of continuous positive airway pressure (CPAP) guided by FiO2 and less invasive surfactant administration (LISA) in infants born at 30–34 weeks’ gestational age (GA). We compared maternal and neonatal variables between cohorts of preterm infants born January 2017–Sept 2018, (pre-RCP) and Oct 2018–Dec 2020 (post-RCP). Infants receiving CPAP for ≥24 h were included and infants intubated at birth were excluded. Compared to pre-RCP (n = 325), the post-RCP (n = 395) cohort had higher exposure to antenatal steroid, lower median GA, and received higher CPAP in the delivery room, at admission, and before surfactant therapy. Similarly, the need for mechanical ventilation was lower within the first 72 h of life and during the hospital stay in the post –RCP cohort. Implementation of an RCP decreased the need for mechanical ventilation in 30–34 weeks’ GA infants.