{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T07:09:44Z","timestamp":1773644984167,"version":"3.50.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Invasive surfactant delivery via endotracheal intubation increases exposure to invasive mechanical ventilation (IMV) in extremely preterm infants (EPIs, &amp;lt;28 weeks). This quality improvement (QI) initiative aimed to evaluate whether minimally invasive surfactant administration (MISA) was associated with a reduced IMV burden in EPIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A single-center retrospective QI study (2013\u20132024) included 115 infants (24\u201327\u207a\u2076 weeks) with spontaneous breathing diagnosed with respiratory distress syndrome (RDS). Controls (2013\u20132019,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200955) received surfactant via intubation; the MISA group (2020\u20132024,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200960) received surfactant via thin catheter during nasal continuous positive airway pressure\/nasal intermittent positive pressure ventilation (NCPAP\/NIPPV). Apart from the structured implementation of MISA, background respiratory and supportive care practices evolved gradually over time without other major structural changes. Multivariable regression and interrupted time-series analyses were performed to account for potential confounding and secular trends.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline infant characteristics were comparable. The median duration of IMV within the first 72\u2005h after birth was 0\u2005h (IQR: 0\u20130) in the MISA group compared to 71.0\u2005h (IQR: 19.0\u201372.0) in the control group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), and the difference remained significant after adjustment. Additionally, total IMV duration was reduced [0\u2005h (IQR: 0\u201314) vs. 111\u2005h (IQR: 39\u2013264);\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001], while non-invasive ventilation (NIV) duration was longer [51.5d (IQR: 41\u201357) vs. 37d (IQR 30\u201350);\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001]. Lower incidences of hemodynamically significant patent ductus arteriosus (hsPDA) (35.0% vs. 69.1%;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and nosocomial pneumonia (18.9% vs. 67.9%;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) were observed during the MISA implementation period, with consistent findings after multivariable adjustment. No significant differences were observed in severe intraventricular hemorrhage (IVH grade 3\u20134) (8.33% vs. 20.4%;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.123), mortality (6.7% vs. 16.4%;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.101), or other secondary outcomes (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05). Interrupted time-series analysis demonstrated an immediate reduction in early IMV duration following MISA implementation, whereas changes in secondary outcomes did not reach statistical significance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MISA was associated with reduced early and overall IMV exposure in EPIs &amp;lt;28 weeks, and with lower observed incidences of hsPDA and nosocomial pneumonia. These associations warrant confirmation in prospective multicenter studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1780241","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T06:37:02Z","timestamp":1773643022000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Minimally invasive surfactant administration in extremely preterm infants &lt;28 weeks gestation with spontaneous breathing: a retrospective quality improvement study on reducing invasive ventilation burden"],"prefix":"10.3389","volume":"14","author":[{"given":"Wenxin","family":"Dong","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Peking University Third Hospital","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Peking University Third 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