Ellen de Kort

57 Less Invasive Surfactant Administration without sedation 4 Total number of patients with GA <32 weeks treated with LISA (n = 111) Missing data regarding success and technical quality of LISA (n = 25) Total number of LISA procedures available for analysis of success and technical quality (n = 86) Data on vital parameters not stored in data warehouse (n = 29) Vital parameters not retrievable because missing exact starting time of LISA (n = 20) Total number of LISA procedures available for vital parameter analysis (n = 37) Figure 1. Study flow chart Success of LISA attempts The LISA procedure was successful at the first attempt in only 45 patients (52%). In 32 patients (37%) 2 attempts were required and in 9 patients (11%) 3 attempts were needed. Reported reasons for failure of first attempts were: inability to visualize the vocal cords in 11 (27%), interruption of the procedure because of significant surfactant spill in 4 (10%), dislocation of the catheter during surfactant administration in 4 (10%), inability to introduce the catheter between the vocal cords in 5 (12%), worsening condition of the patient in 5 (12%), patient resistance in 1 (2%), and other reasons in 4 attempts (10%). In 7 attempts (17%) the reason for failure was not reported. The first attempt was performed by a pediatric resident in 7 procedures (8%), a neonatal nurse specialist in 22 procedures (26%), a fellow in neonatology in 10 procedures (12%) and a neonatologist in 46 procedures (53%). Pediatric residents were successful in only 2 attempts (29%), neonatal nurse specialists were successful in 7 attempts (32%), fellows in neonatologywere successful in 3 attempts (30%) and neonatologists were successful in 33 attempts (72%) (p = 0.003). Table 2a shows patient characteristics and experience of the performer in successful and failed first attempts. These results show there are no statistically significant differences in patient characteristics between LISAprocedures inwhich the first attempt was successful