This study is an interventional, non-pharmacological, multicentric, randomized, controlled, superiority, non-profit study. Its primary objective is to evaluate if the administration of surfactant based on FOT assessment will allow a 5-day reduction in the duration of respiratory support as compared to standard practice in preterm infants between 27+0 and 32+6 weeks' gestation. The secondary objectives are: 1. to determine if a lung mechanics-based approach for administering surfactant will change treatment timing; and 2. to assess the impact of the novel approach on other neonatal general outcomes. The study will take place within the neonatal intensive care units. Non-invasive respiratory support will be delivered by nasal CPAP with a starting pressure of 5-8 cmH2O. FiO2 will be titrated in order to achieve the target SpO2 91-95%. Infants matching the clinical criteria for inclusion will be randomized in two arms following the current data protection and confidentiality regulations. Central, computer-generated randomization (allocation 1:1) with variable block sizes according to gestational age will be used. Infants will be stratified according to gestational age (27+0 -28+6 weeks; 29+0 -30+6 weeks; 31+0 -32+6 weeks) and center. Study Arms: A) Surfactant administration following oxygenation-based criteria (clinical assessment) (control) B) Surfactant administration following both lung mechanics assessment OR oxygenation-based criteria (clinical assessment) (intervention).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
458
Surfactant is administered following oxygenation-based criteria and if the Xrs is ≤ -23.3 cmH2O\*s /L
Surfactant is administered following oxygenation-based criteria
Days of respiratory support
Number of days of required respiratory support
Time frame: From date of randomization until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 48 months"
First surfactant administration
Time of first surfactant administration (in hours)
Time frame: From date of randomization until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 48 months"
Days of non-invasive respiratory support
Number of days of non-invasive respiratory support
Time frame: From date of randomization until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 48 months"
Days of invasive respiratory support
Number of days of invasive respiratory support
Time frame: From date of randomization until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 48 months"
Patients intubated and mechanically ventilated
Number of patients intubated and mechanically ventilated
Time frame: From date of randomization until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 48 months"
Patients receiving multiple surfactant doses
Number of patients receiving multiple surfactant doses
Time frame: From date of randomization until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 48 months"
Days on supplemental oxygen
Number of days on supplemental oxygen
Time frame: From date of randomization until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 48 months"
Total cumulative oxygen exposure
Total cumulative oxygen exposure computed as the time integral of the FiO2 values
Time frame: From date of randomization until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 48 months"
Infants receiving more than 28 days of respiratory support
Number of infants receiving more than 28 days of respiratory support
Time frame: From date of randomization until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 48 months"
Infants developing BPD
Number of infants developing BPD according to the definition by NICHD 2016
Time frame: From date of randomization until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 48 months"
Infants developing air-leaks
Number of infants developing air-leaks
Time frame: From date of randomization until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 48 months"
Infants developing prematurity-associated complications
Number of infants developing prematurity-associated complications (severe intraventricular haemorrhage (IVH), periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC), sepsis, retinopathy of prematurity (ROP), patent ductus arteriosus requiring pharmacological or surgical treatment)
Time frame: From date of randomization until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 48 months"
Infants discharged home with oxygen or respiratory support
Number of infants discharged home with oxygen or respiratory support
Time frame: From date of randomization until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 48 months"
Days to achieve full-enteral feeding
Number of days to achieve full-enteral feeding (160 ml/kg/day of milk intake)
Time frame: From date of randomization until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 48 months"
Days of hospitalization
Number of days of hospitalization
Time frame: From date of randomization until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 48 months"
Infants receiving postnatal steroids
Number of infants receiving postnatal steroids
Time frame: From date of randomization until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 48 months"
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