Background The majority of extremely low gestational age neonates undergo intubation for surfactant therapy. Less invasive surfactant administration (LISA) uses a thin catheter inserted into the trachea to deliver the surfactant. During the procedure, the infant is breathing spontaneously while supported with continuous positive airway pressure. Although LISA is widely adapted in Europe and Australia, the rate of LISA use in the United States is unknown. Study design The aim of this study is to evaluate the use of LISA in the US. A web-based survey was distributed via SurveyMonkey to 2550 neonatologists from AAP's SoNPM mailing list. Results Of the 472 neonatologists who answered the survey, 15% used LISA either as a part of routine care (8%) or as part of research (7%). Conclusion Unlike several regions of Europe, LISA is not widely used in the US. Future studies should address ambiguities regarding infant selection, procedure training and "roadblocks" to its broader application.

Dr Smithhart conceptualized and designed the study, merged the spreadsheets of the 2 databases, and wrote the first draft of the manuscript; Drs Wyckoff, Jaleel, Kapadia, Nelson, and Kakkilaya conceptualized and designed the study; Mr Brown conducted statistical analyses; Dr Brion conceptualized and designed the study and conducted statistical analyses; and all authors participated in the interpretation of the data, critically reviewed the revisions, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work.

Use of a visual aid improved mothers' knowledge and showed promise as a decision aid for counseling at the threshold of viability.

Avoiding delivery room intubation (DRI) and stabilization of preterm infants on continuous positive airway pressure (CPAP) reduces death and bronchopulmonary dysplasia (BPD). 1-3 The Neonatal Resuscitation Program (NRP) suggests that spontaneously breathing preterm infants with respiratory distress may be supported with CPAP. 4 However, the majority of extremely low gestational age (GA) neonates receive face mask positive pressure ventilation (Fm-PPV) in the delivery room (DR). 5-7 Inadequate Fm-PPV during these crucial initial minutes after birth may result in persistent hypoxia and bradycardia, necessitating emergent intubation. Airway obstruction 8-10 and mask leak 9, 10 are common during Fm-PPV. The NRP recommends certain steps (mask seal, repositioning head, suction, open mouth, and increase pressure [MRSOP]) to optimize Fm-PPV before resorting to intubation. 11, 12 In addition, the use of colorimetric end-tidal

Objective To evaluate the impact of the Neonatal Resuscitation Program (NRP) recommended low oxygen strategy on neonatal morbidities, mortality and neurodevelopmental outcomes in preterm neonates. Study design In March 2011, Parkland Hospital changed from a high oxygen strategy (HOX) of resuscitation with initial 100% O2 and targeting 85–94% SpO2 for delivery room (DR) resuscitation to a low oxygen strategy (LOX) with initial 21% O2 and titrating O2 to meet NRP recommended transitional target saturations. Neonates ≤28 weeks gestational age (GA) born between August 2009 and April 2012 were identified. In this retrospective, observational study, neonates exposed to LOX versus HOX were compared for short-term morbidity, mortality and long-term neurodevelopmental outcomes. Regression analysis was performed to control for confounding variables. Results Of 199 neonates, 110 were resuscitated with HOX and 89 with LOX. Compared with HOX, LOX neonates had lower O2 exposure in the DR (5.2 ± 1.5 vs 7.8 ± 2.8 (ΣFiO2 × Time min), P < .01), spent fewer days on O2 (30 (5, 54) vs 46 (11, 82), p=0.01) and had lower odds of developing bronchopulmonary dysplasia (BPD) (adjusted odds ratio 0.4(0.2, 0.9)). There was no difference in mortality (17(20%) vs 20(18%)), but LOX neonates had higher motor composite scores on Bayley III assessment (91 (85, 97) vs 88 (76, 94), p<0.01). Conclusion The NRP recommended LOX strategy was associated with improved respiratory morbidities and neurodevelopmental outcomes with no increase in mortality. Prospective trials to confirm the optimal oxygen strategy for the resuscitation of preterm neonates are needed.