{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T11:05:27Z","timestamp":1784286327483,"version":"3.55.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e0 degli Studi di Bari Aldo Moro"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    NIV and early targeted endotracheal surfactant administration play a pivotal role in the treatment of RDS and other respiratory conditions in neonates. LISA and INSURE are the most widely used techniques for surfactant delivery.  This multicentre retrospective registry-based cohort study, conducted in\u00a0three Southern Italy Neonatal Intensive Care Units\u00a0between January 2024 and March 2025, aimed to compare their effectiveness.\u00a0Neonates who received NIV soon after birth and rescue surfactant via either INSURE or LISA were included. Treatment failure was defined as the need for a second dose of surfactant or the need for intubation and mechanical ventilation within 72\u00a0h of life. The secondary outcomes were the incidence of BPD at 36\u00a0weeks post-menstrual age or at discharge and impact of the applied NIV mode on outcomes within the LISA subgroup. Sixty-one neonates were enrolled: 29 LISA group (48%) and 32 INSURE group (52%). No significant differences were observed in the need for a second surfactant dose (LISA 38% vs INSURE 19%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.095) or mechanical ventilation within the first 72\u00a0h of life (LISA 17% vs INSURE 9%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.460). BPD incidence was low and comparable between groups (LISA 7% vs INSURE 3%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.600). In LISA-treated neonates, HFNC, nCPAP, and NIPPV showed comparable effects on primary and secondary outcomes, while oxygen supplementation duration was significantly shorter with NIPPV (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.014).\n                    <jats:italic>Conclusion<\/jats:italic>\n                    :\u00a0LISA and INSURE are equally effective modalities for surfactant administration in neonates with no significant differences.\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What Is Known:<\/jats:bold>\n                              <jats:italic>\u2022 Less invasive surfactant administration (LISA) is currently recommended by the latest European guidelines as the preferred method for surfactant delivery in spontaneously breathing infants on non-invasive ventilation (NIV).<\/jats:italic>\n                              <jats:italic>\u2022 Previous studies suggested that LISA and INSURE have similar safety and effectiveness, with comparable short- and long-term outcomes.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              <jats:italic>\u2022 In this study, the need for a second dose of surfactant was explicitly considered as a marker of LISA failure.<\/jats:italic>\n                              <jats:italic>\u2022 LISA and INSURE techniques are comparable in reducing the need for mechanical ventilation and have similar major clinical outcomes, including BPD. There was a trend toward a higher rate of surfactant retreatment in the LISA group, without reaching statistical significance (p\u2009=\u20090.095). This was not associated with increased intubation or adverse outcomes, suggesting a potential stepwise non-invasive management strategy rather than true therapeutic failure.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-026-07118-8","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T02:31:05Z","timestamp":1780453865000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of LISA and INSURE techniques for surfactant administration: a multicentre retrospective study"],"prefix":"10.1007","volume":"185","author":[{"given":"Raffaella","family":"Panza","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossella","family":"Caravita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigia","family":"Valenzano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Martinelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Farella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Guida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Quercia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Latorre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Laforgia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"7118_CR1","doi-asserted-by":"publisher","unstructured":"Yadav S, Lee B (2023) Neonatal respiratory distress syndrome. Care planning in children and young people\u2019s nursing: second edition 161\u2013167. https:\/\/doi.org\/10.1002\/9781119819653.ch19","DOI":"10.1002\/9781119819653.ch19"},{"key":"7118_CR2","doi-asserted-by":"publisher","unstructured":"Sweet DG, Carnielli VP, Greisen G et al (2026) European consensus guidelines on the management of respiratory distress syndrome: 2025. Neonatology 1\u201326. https:\/\/doi.org\/10.1159\/000551062","DOI":"10.1159\/000551062"},{"key":"7118_CR3","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1159\/000528914","volume":"120","author":"DG Sweet","year":"2023","unstructured":"Sweet DG, Carnielli VP, Greisen G et al (2023) European consensus guidelines on the management of respiratory distress syndrome: 2022 update. Neonatology 120:3\u201323. https:\/\/doi.org\/10.1159\/000528914","journal-title":"Neonatology"},{"key":"7118_CR4","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001456.PUB2\/INFORMATION\/EN","author":"FL Bahadue","year":"2012","unstructured":"Bahadue FL, Soll R (2012) Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev. https:\/\/doi.org\/10.1002\/14651858.CD001456.PUB2\/INFORMATION\/EN","journal-title":"Cochrane Database Syst Rev"},{"key":"7118_CR5","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000510.PUB2","author":"MX Rojas-Reyes","year":"2012","unstructured":"Rojas-Reyes MX, Morley CJ, Soll R (2012) Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev. https:\/\/doi.org\/10.1002\/14651858.CD000510.PUB2","journal-title":"Cochrane Database Syst Rev"},{"key":"7118_CR6","first-page":"11","volume":"13","author":"K Altirkawi","year":"2013","unstructured":"Altirkawi K (2013) Surfactant therapy: the current practice and the future trends. Sudan J Paediatr 13:11","journal-title":"Sudan J Paediatr"},{"key":"7118_CR7","doi-asserted-by":"publisher","DOI":"10.1007\/S00431-025-06191-9","author":"S Hooda","year":"2025","unstructured":"Hooda S, Dalal JS, Bhalla K et al (2025) Less invasive surfactant administration (LISA) versus intubation surfactant extubation (InSurE) technique using higher volume surfactant in management of neonates with respiratory distress syndrome: an open-label randomized controlled trial. Eur J Pediatr. https:\/\/doi.org\/10.1007\/S00431-025-06191-9","journal-title":"Eur J Pediatr"},{"key":"7118_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.23750\/ABM.V91I4.8845","volume":"91","author":"M Silahli","year":"2020","unstructured":"Silahli M, Tekin M (2020) The comparison of lisa and insure techniques in term of neonatal morbidities and mortality among premature infants. Acta Biomed 91:1\u20137. https:\/\/doi.org\/10.23750\/ABM.V91I4.8845","journal-title":"Acta Biomed"},{"key":"7118_CR9","doi-asserted-by":"publisher","first-page":"F655","DOI":"10.1136\/ARCHDISCHILD-2018-316557","volume":"104","author":"E Herting","year":"2019","unstructured":"Herting E, H\u00e4rtel C, G\u00f6pel W (2019) Less invasive surfactant administration (LISA): chances and limitations. Arch Dis Child Fetal Neonatal Ed 104:F655\u2013F659. https:\/\/doi.org\/10.1136\/ARCHDISCHILD-2018-316557","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"7118_CR10","doi-asserted-by":"publisher","DOI":"10.1177\/2333794X17696683","author":"CSM Lau","year":"2017","unstructured":"Lau CSM, Chamberlain RS, Sun S (2017) Less invasive surfactant administration reduces the need for mechanical ventilation in preterm infants: a meta-analysis. Glob Pediatr Health. https:\/\/doi.org\/10.1177\/2333794X17696683","journal-title":"Glob Pediatr Health"},{"key":"7118_CR11","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.25810","volume":"5","author":"C H\u00e4rtel","year":"2022","unstructured":"H\u00e4rtel C, Herting E, Humberg A et al (2022) Association of administration of surfactant using less invasive methods with outcomes in extremely preterm infants less than 27 weeks of gestation. JAMA Netw Open 5:e2225810. https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.25810","journal-title":"JAMA Netw Open"},{"key":"7118_CR12","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1136\/archdischild-2020-319763","volume":"106","author":"I Bellos","year":"2021","unstructured":"Bellos I, Fitrou G, Panza R, Pandita A (2021) Comparative efficacy of methods for surfactant administration: a network meta-analysis. Arch Dis Child Fetal Neonatal Ed 106:474\u2013487. https:\/\/doi.org\/10.1136\/archdischild-2020-319763","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"7118_CR13","doi-asserted-by":"publisher","DOI":"10.3390\/antiox12061149","author":"G Bal\u00e1zs","year":"2023","unstructured":"Bal\u00e1zs G, Balajthy A, Seri I et al (2023) Prevention of chronic morbidities in extremely premature newborns with LISA-nCPAP respiratory therapy and adjuvant perinatal strategies. Antioxidants Basel. https:\/\/doi.org\/10.3390\/antiox12061149","journal-title":"Antioxidants Basel"},{"key":"7118_CR14","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1891\/NN-2024-0038","volume":"44","author":"M Albertson","year":"2025","unstructured":"Albertson M, Forbush J (2025) Respiratory management of the extremely premature infant. Neonatal Netw 44:107\u2013113. https:\/\/doi.org\/10.1891\/NN-2024-0038","journal-title":"Neonatal Netw"},{"key":"7118_CR15","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1177\/00099228231152859","volume":"62","author":"X Zhang","year":"2023","unstructured":"Zhang X, Pan J, Zhu L et al (2023) Less invasive surfactant administration for the treatment of neonatal respiratory distress syndrome combined with noninvasive ventilation in Anhui Province, China: a retrospective cohort study. Clin Pediatr (Phila) 62:1109\u20131117. https:\/\/doi.org\/10.1177\/00099228231152859","journal-title":"Clin Pediatr (Phila)"},{"key":"7118_CR16","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011672.pub2","volume":"2021","author":"ME Abdel-Latif","year":"2021","unstructured":"Abdel-Latif ME, Davis PG, Wheeler KI et al (2021) Surfactant therapy via thin catheter in preterm infants with or at risk of respiratory distress syndrome. Cochrane Database Syst Rev 2021:CD011672. https:\/\/doi.org\/10.1002\/14651858.CD011672.pub2","journal-title":"Cochrane Database Syst Rev"},{"key":"7118_CR17","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","volume":"61","author":"E von Elm","year":"2008","unstructured":"von Elm E, Altman DG, Egger M et al (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344\u2013349. https:\/\/doi.org\/10.1016\/j.jclinepi.2007.11.008","journal-title":"J Clin Epidemiol"},{"key":"7118_CR18","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1097\/MOP.0000000000000878","volume":"32","author":"E Herting","year":"2020","unstructured":"Herting E, H\u00e4rtel C, G\u00f6pel W (2020) Less invasive surfactant administration: best practices and unanswered questions. Curr Opin Pediatr 32:228\u2013234. https:\/\/doi.org\/10.1097\/MOP.0000000000000878","journal-title":"Curr Opin Pediatr"},{"key":"7118_CR19","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1164\/AJRCCM.163.7.2011060","volume":"163","author":"AH Jobe","year":"2001","unstructured":"Jobe AH, Bancalari E (2001) Bronchopulmonary dysplasia. Am J Respir Crit Care Med 163:1723\u20131729. https:\/\/doi.org\/10.1164\/AJRCCM.163.7.2011060","journal-title":"Am J Respir Crit Care Med"},{"key":"7118_CR20","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1164\/RCCM.201812-2348OC","volume":"200","author":"K Dysart","year":"2019","unstructured":"Dysart K, Gantz MG, McDonald S et al (2019) The diagnosis of bronchopulmonary dysplasia in very preterm infants. An evidence-based approach. Am J Respir Crit Care Med 200:751\u2013759. https:\/\/doi.org\/10.1164\/RCCM.201812-2348OC","journal-title":"Am J Respir Crit Care Med"},{"key":"7118_CR21","doi-asserted-by":"publisher","first-page":"233","DOI":"10.3233\/NPM-230194","volume":"17","author":"M Mansouri","year":"2024","unstructured":"Mansouri M, Servatyari K, Rahmani K et al (2024) Surfactant administration methods for premature newborns: LISA vs. INSURE comparative analysis. J Neonatal Perinatal Med 17:233\u2013239. https:\/\/doi.org\/10.3233\/NPM-230194","journal-title":"J Neonatal Perinatal Med"},{"key":"7118_CR22","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1159\/000537903","volume":"121","author":"I Kuitunen","year":"2024","unstructured":"Kuitunen I, R\u00e4s\u00e4nen K (2024) Less invasive surfactant administration compared to intubation, surfactant, rapid extubation method in preterm neonates: an umbrella review. Neonatology 121:485\u2013493. https:\/\/doi.org\/10.1159\/000537903","journal-title":"Neonatology"},{"key":"7118_CR23","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-024-03429-4","volume":"24","author":"S Liu","year":"2024","unstructured":"Liu S, Wang Y, Zhu X et al (2024) Comparative efficacy and safety of pulmonary surfactant delivery strategies in neonatal RDS: a network meta-analysis. BMC Pulm Med 24:637. https:\/\/doi.org\/10.1186\/s12890-024-03429-4","journal-title":"BMC Pulm Med"},{"key":"7118_CR24","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1007\/s00431-020-03682-9","volume":"179","author":"BK Gupta","year":"2020","unstructured":"Gupta BK, Saha AK, Mukherjee S, Saha B (2020) Minimally invasive surfactant therapy versus InSurE in preterm neonates of 28 to 34 weeks with respiratory distress syndrome on non-invasive positive pressure ventilation\u2014a randomized controlled trial. Eur J Pediatr 179:1287\u20131293. https:\/\/doi.org\/10.1007\/s00431-020-03682-9","journal-title":"Eur J Pediatr"},{"issue":"6","key":"7118_CR25","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-025-06191-9","volume":"184","author":"S Hooda","year":"2025","unstructured":"Hooda S, Dalal JS, Bhalla K et al (2025) Less invasive surfactant administration (LISA) versus intubation surfactant extubation (InSurE) technique using higher volume surfactant in management of neonates with respiratory distress syndrome: an open-label randomized controlled trial. Eur J Pediatr 184(6):371. https:\/\/doi.org\/10.1007\/s00431-025-06191-9","journal-title":"Eur J Pediatr"},{"key":"7118_CR26","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1038\/s41372-020-00779-9","volume":"41","author":"H Coshal","year":"2021","unstructured":"Coshal H, Mukerji A, Lemyre B et al (2021) Characteristics and outcomes of preterm neonates according to number of doses of surfactant received. J Perinatol 41:39\u201346. https:\/\/doi.org\/10.1038\/s41372-020-00779-9","journal-title":"J Perinatol"},{"key":"7118_CR27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2023.113535","volume":"261","author":"L Lanciotti","year":"2023","unstructured":"Lanciotti L, Pasqualini M, Correani A et al (2023) Who needs a second dose of exogenous surfactant? J Pediatr 261:113535. https:\/\/doi.org\/10.1016\/j.jpeds.2023.113535","journal-title":"J Pediatr"},{"key":"7118_CR28","doi-asserted-by":"publisher","first-page":"200","DOI":"10.12956\/TCHD.571497","volume":"14","author":"K G\u00f6k\u00e7e","year":"2020","unstructured":"G\u00f6k\u00e7e K, Di\u0307zdar AE, Yurttutan S et al (2020) Surfactant treatment in late preterm and term newborns; indications and outcomes. Turkish Journal of Pediatric Disease 14:200\u2013206. https:\/\/doi.org\/10.12956\/TCHD.571497","journal-title":"Turkish Journal of Pediatric Disease"},{"issue":"1","key":"7118_CR29","doi-asserted-by":"publisher","DOI":"10.1186\/S13052-024-01828-1","volume":"51","author":"C Dani","year":"2025","unstructured":"Dani C, Poggi C, Agosti M et al (2025) Clinical predictors for surfactant retreatment in preterm infants with respiratory distress syndrome: the results of a pooled analysis. Ital J Pediatr 51(1):1. https:\/\/doi.org\/10.1186\/S13052-024-01828-1","journal-title":"Ital J Pediatr"},{"key":"7118_CR30","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/S2352-4642(19)30405-5","volume":"4","author":"D De Luca","year":"2020","unstructured":"De Luca D, Shankar-Aguilera S, Centorrino R et al (2020) Less invasive surfactant administration: a word of caution. Lancet Child Adolesc Health 4:331\u2013340. https:\/\/doi.org\/10.1016\/S2352-4642(19)30405-5","journal-title":"Lancet Child Adolesc Health"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-07118-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-026-07118-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-07118-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T10:25:55Z","timestamp":1784283955000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-026-07118-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,3]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["7118"],"URL":"https:\/\/doi.org\/10.1007\/s00431-026-07118-8","relation":{},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,3]]},"assertion":[{"value":"6 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 May 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 May 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 June 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical approval was not required, as this was a retrospective cohort study of routine practice based on the review of previously collected anonymized clinical data. In accordance with Italian regulations (Legislative Decree No. 196\/2003 and EU Regulation 2016\/679), studies based on anonymized data are exempt from ethics committee review.","order":1,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from the parents.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"461"}}