Preterm birth, defined as delivery before 37 weeks of gestation, remains a significant cause of neonatal morbidity and mortality worldwide despite advances in perinatal care. Klaristenfeld’s article begins with a candid recounting of their family’s encounter with this challenging condition, setting the stage for a nuanced examination of what modern neonatology involves. The initial shock and uncertainty that parents face are not just emotional but are deeply rooted in the unpredictable health trajectories of preterm infants, who may face respiratory, neurological, and metabolic challenges.

Central to the medical understanding of prematurity is the recognition of lung immaturity as a critical concern. Klaristenfeld details how neonatal intensive care units (NICUs) employ surfactant replacement therapy—a biochemical treatment that compensates for the deficiency of surfactant in preterm infant lungs, which is essential for keeping alveoli open and effective gas exchange. This therapeutic intervention has significantly reduced mortality rates. However, the article draws attention to how the variability in individual responses to surfactant and mechanical ventilation strategies can complicate clinical outcomes.

In addition to respiratory support, the article delves into the subtleties of neurodevelopmental risk factors associated with preterm birth. Klaristenfeld explains how the brain of a preterm infant remains vulnerable due to incomplete myelination and synaptogenesis. Advanced imaging techniques such as diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS) are employed to monitor brain development, allowing clinicians to identify early markers of potential cognitive and motor impairments, thereby tailoring interventions to optimize neurological outcomes.

The article also explores the metabolic intricacies faced by premature neonates, particularly emphasizing the challenges in maintaining glucose homeostasis and thermoregulation. Klaristenfeld sheds light on how disrupted glucose metabolism can precipitate hypoglycemia or hyperglycemia, both of which have lasting impacts on neurodevelopment. Sophisticated monitoring technology in NICUs ensures tight regulation of glucose levels, but the delicate balance remains difficult to maintain, especially in the smallest and most vulnerable infants.

From a psychosocial perspective, Klaristenfeld eloquently describes the impact of prolonged NICU stays on the family unit. The article highlights research indicating elevated parental stress, anxiety, and depression during and after hospitalization of preterm infants. These mental health aspects are critical because they influence caregiver-infant bonding and longitudinal developmental outcomes. The article advocates for integrating psychological support services as a standard component of neonatal care to promote holistic recovery.

Klaristenfeld’s narrative seamlessly transitions to the technological innovations shaping the future of neonatal medicine. Among these are the deployment of closed incubators equipped with real-time vital sign monitoring, automated oxygen titration systems to reduce oxidative stress, and telemedicine protocols that enhance remote specialist consultations. These advancements not only improve immediate survival rates but also contribute to reducing the long-term complications associated with preterm birth.

A revealing portion of the article addresses the evolving landscape of genetic research and its application to neonatology. Klaristenfeld discusses emerging evidence on genetic predispositions influencing preterm labor and infant resilience. Genome-wide association studies (GWAS) are enabling researchers to pinpoint genetic loci linked to premature delivery, which may eventually inform personalized therapeutic strategies to prevent or mitigate the impact of prematurity.

Another technical layer involves addressing the inflammatory processes implicated in preterm birth and subsequent neonatal morbidity. The author outlines how intra-amniotic infections trigger an inflammatory cascade that compromises fetal development, leading to conditions such as bronchopulmonary dysplasia (BPD). Advanced biomarker profiling, including cytokine panels, is critical in early identification and management of these inflammatory states, underscoring the convergence of immunology and neonatology.

The article does not shy away from the socioeconomic and ethical dimensions of prematurity. Klaristenfeld reflects on disparities in access to cutting-edge neonatal care and the difficult decisions involved in aggressive interventions for extremely preterm infants at the edge of viability. These discussions illuminate how technological capabilities must be balanced with ethical frameworks and family-centered care principles, emphasizing quality of life alongside survival.

Importantly, the article champions the concept of developmental care, which integrates the NICU environment modifications aimed at optimizing sensory inputs and reducing stress for preterm infants. This encompasses strategies such as kangaroo mother care (skin-to-skin contact), controlled lighting and noise, and individualized pain management. Klaristenfeld notes how such practices are linked with improved physiological stability and better neurobehavioral outcomes.

Building on the family’s story, the article offers insights into the evolving role of parents as active participants in neonatal care. Moving beyond passive visitation, parents are increasingly trained and encouraged to engage in caregiving activities, which enhances their confidence and contributes to positive infant development. This participatory approach is a significant shift toward family-centered care, highlighting the intersection of medical science with human experience.

Looking forward, Klaristenfeld envisions a future where multidisciplinary collaborations—spanning neonatology, genetics, bioengineering, and psychology—drive transformative improvements for preterm infants. The integration of artificial intelligence (AI) in predictive analytics and personalized treatment protocols shows promise to revolutionize neonatal outcomes. However, the article emphasizes that the cornerstone remains compassionate care informed by sound science.

Ultimately, this article is a testament to the resilience of families navigating the unpredictable journey of prematurity and the relentless quest of the scientific community to unravel the mysteries of early human development. The confluence of detailed medical knowledge and heartfelt narrative provides a vital contribution to both clinical practice and public understanding, making the invisible challenges of preterm birth sharply visible.

As Klaristenfeld poignantly concludes, the journey with prematurity is as much a story of technological marvels and biological complexity as it is of hope, courage, and the unbreakable human spirit. Through comprehensive neonatal care and ongoing research, the future for preterm infants continues to brighten, promising not just survival but thriving lives.

Subject of Research: Family experiences and scientific perspectives on preterm birth, including neonatal care, developmental challenges, and medical interventions.

Article Title: Family reflections: our journey with preterm birth

Article References:
Klaristenfeld, J. Family reflections: our journey with preterm birth. Pediatr Res (2026). https://doi.org/10.1038/s41390-025-04607-8

Image Credits: AI Generated

DOI: https://doi.org/10.1038/s41390-025-04607-8

Pulmonary surfactant, a complex mixture of lipids and proteins, is fundamental to reducing surface tension in the alveoli and maintaining pulmonary stability. Surfactant replacement therapy has revolutionized neonatal care for infants born prematurely with respiratory distress syndrome (RDS). However, variations in treatment efficacy have been observed in infants exhibiting additional pulmonary comorbidities such as bronchopulmonary dysplasia (BPD), persistent pulmonary hypertension of the newborn (PPHN), and congenital pulmonary malformations. This study meticulously stratifies these comorbidities to assess their precise impact on surfactant responsiveness in late preterm babies.

Utilizing data collected from multiple neonatal intensive care units (NICUs) across Europe, the researchers conducted an extensive cohort study involving hundreds of late preterm infants receiving surfactant therapy. Sophisticated statistical models were employed to isolate the effects of specific pulmonary comorbidities from confounding variables, such as gestational age variations, birth weight, and antenatal steroid exposure. The results elucidate that certain comorbidities markedly diminish the effectiveness of standard surfactant formulations, suggesting the need for modified therapeutic strategies.

One of the pivotal discoveries in this study is the differential response related to the presence of inflammatory lung diseases. Infants with underlying pulmonary inflammation showed a significantly blunted improvement in oxygenation indices following surfactant administration compared to their counterparts without inflammation. This finding underscores the crucial interplay between inflammatory processes and surfactant function, providing a potential mechanistic explanation involving surfactant protein degradation and impaired biophysical activity within inflamed alveoli.

Furthermore, the study highlights that late preterm infants with pulmonary hypertension experience altered pulmonary vascular reactivity that interferes with the distribution and efficacy of surfactant delivered via conventional routes. These infants demonstrated protracted ventilatory support requirements and a higher incidence of supplemental oxygen dependency beyond the neonatal period. This observation compels the neonatal community to reconsider current administration protocols, possibly incorporating adjunctive pharmacological agents aimed at modulating vascular tone to optimize surfactant distribution.

Strikingly, the presence of congenital pulmonary malformations such as congenital pulmonary airway malformation (CPAM) or bronchogenic cysts created complex scenarios where surfactant therapy alone failed to reverse respiratory dysfunction effectively. The anatomical aberrations disrupted normal alveolar architecture and surfactant compartmentalization, indicating that surgical correction may be necessary before surfactant therapy can yield optimal results. This revelation calls for a more integrated approach that combines imaging diagnostics, surgical evaluation, and respiratory support strategies in late preterm infants.

The implications of these findings extend beyond immediate treatment protocols. They signify that neonatal intensive care providers must adopt a more nuanced, individualized approach to surfactant replacement therapy, recognizing the heterogeneity within the late preterm population. Precision medicine approaches, integrating patient-specific pulmonary pathology profiles, may enhance survival rates and long-term respiratory outcomes in this fragile demographic. Tailoring surfactant type, dose, and administration technique based on comorbidity profiles may become standard practice in the near future.

Moreover, the study delves into the biochemical alterations in surfactant composition and function associated with different pulmonary comorbidities. Advanced analytical techniques, including mass spectrometry and immunoassays, revealed that surfactant extracted from infants with complicated pulmonary disease exhibits altered lipid-protein ratios and dysfunctional surfactant proteins critical for stability and spreadability. Such molecular insights provide tangible targets for designing next-generation synthetic surfactants or adjunct treatments that replenish deficient components or protect surfactant from inflammatory degradation.

In addition to the biochemical dimension, the research team used high-resolution imaging and lung function measurements to correlate structural abnormalities with functional responses to surfactant therapy. This comprehensive phenotyping approach allowed for the identification of phenotypic biomarkers predictive of poor therapeutic outcomes, enabling early risk stratification and intervention customization. The integration of imaging biomarkers with biochemical data marks a transformative leap in neonatal respiratory research, pointing toward multimodal diagnostics as a cornerstone of future surfactant therapy optimization.

Equally noteworthy is the study’s impact on understanding surfactant pharmacokinetics and biodistribution in the context of pulmonary comorbidities. The researchers used radiolabeled surfactant preparations to track lung deposition in various pathological conditions, revealing that abnormal alveolar-capillary barriers and altered pulmonary fluid dynamics profoundly affect surfactant dispersion and clearance. These insights could inform modified delivery methods, including aerosolized surfactant or surfactant combined with therapeutic nanoparticles, to overcome delivery barriers in diseased lungs.

While surfactant therapy had historically been one-size-fits-all, this study elucidates the importance of precision dosing regimens. Infants with specific comorbidities required adjusted dosing intervals or amounts to achieve adequate alveolar surfactant pools. Over- or under-dosing in these contexts risks exacerbating lung injury or insufficient treatment, respectively. The findings advocate for dynamic dosing algorithms that incorporate real-time markers of lung function and surfactant activity, supported by point-of-care diagnostics.

The study also sheds light on long-term respiratory morbidity related to initial surfactant response variations. Infants with suboptimal therapeutic responses exhibited higher incidences of chronic lung disease and impaired pulmonary function well into infancy and early childhood. These correlations emphasize that early pulmonary comorbidities and surfactant therapy outcomes can have profound lifelong consequences, underscoring the urgency of refining neonatal interventions.

Importantly, the researchers call for further clinical trials that incorporate stratification by pulmonary comorbidity profiles. Such trials are essential to validate tailored surfactant formulations or novel adjunct therapies. The study’s multicenter nature ensures wide applicability of results across diverse healthcare settings but also reveals regional variations in comorbidity prevalence and management practices, highlighting the need for global standardized guidelines informed by these new insights.

In conclusion, this landmark study transforms our understanding of surfactant therapy in late preterm infants by illuminating the significant role of pulmonary comorbidities in shaping treatment outcomes. It bridges molecular biology, pharmacology, and clinical care, offering a comprehensive roadmap for the development of precision respiratory medicine in neonatology. As surfactant replacement continues to be a cornerstone of neonatal intensive care, adapting therapies to address complex pulmonary pathologies holds unprecedented potential to improve survival and quality of life for the most vulnerable newborns.

The research represents a clarion call to clinicians, scientists, and industry to innovate surfactant therapies beyond traditional paradigms and embrace a future of personalized neonatal respiratory care. Neonatologists are now better equipped with the knowledge needed to optimize treatments, mitigate long-term complications, and ultimately enhance the trajectory of infants born at the margins of term. This study not only raises essential scientific questions but also ignites hope for tangible clinical breakthroughs in the care of late preterm infants worldwide.

Subject of Research: Pulmonary comorbidities and their impact on surfactant therapy responsiveness in late preterm infants

Article Title: Pulmonary comorbidities and response to surfactant in late preterm infants: a multicenter cohort study

Article References:
Sadowska-Krawczenko, I., Hożejowski, R., Mazela, J. et al. Pulmonary comorbidities and response to surfactant in late preterm infants: a multicenter cohort study. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04634-5

Image Credits: AI Generated

DOI: 01 December 2025

For premature infants born before the 28th week of gestation, respiratory distress syndrome represents a critical and often fatal challenge. The underlying culprit resides in underdeveloped lungs that fail to produce sufficient pulmonary surfactant—a complex mixture of lipids and proteins that reduces surface tension within the alveoli. Without this natural detergent-like fluid, parts of the lung collapse, severely hampering oxygen exchange. Historically, this condition carried bleak prognoses until pioneering work in the late 20th century introduced surfactant replacement therapies derived from animal sources. Decades of clinical success in neonatology stemmed from this breakthrough. Yet, intriguingly, applying surfactant treatments to adult patients suffering from acute respiratory distress syndrome (ARDS), such as many during the COVID-19 pandemic, failed to replicate neonatal outcomes. This discrepancy suggests that the mechanics governing lung surfactant function are far more intricate than previously imagined, extending beyond simple surface tension reduction.

Emerging research led by Jan Vermant, Professor of Soft Materials at ETH Zurich, sheds new light on the complex biomechanical behavior of pulmonary surfactant films under dynamic respiratory conditions. Collaborating with international scientists, Vermant’s team employed cutting-edge experimental tools to simulate the cyclic stretching and recompression that lung surfaces endure during the breathing cycle. These quantitative measurements move beyond static descriptions to capture how surfactant interfaces transform under mechanical stress that mimics both normal and deep breaths. Their findings, recently published in Science Advances, reveal that the physical properties of surfactant films are actively modulated by breathing patterns, challenging established paradigms and opening avenues for innovative therapeutic strategies.

At the core of their work lies surface stress—a mechanical factor intimately linked to lung compliance, the measure of ease with which lungs expand and recoil. The research demonstrates that after deep inspirations, surface stress of the surfactant film decreases conspicuously, facilitating enhanced lung deformability. This biophysical insight provides a plausible explanation for an age-old physiological mystery: why deep sighs and breaths often induce a palpable sensation of chest relief. In essence, these breaths do not simply bring more air into the lungs but fundamentally reset the structural organization of the surfactant layers, optimizing their mechanical function.

Contrary to earlier assumptions treating pulmonary surfactant as a monolayer, detailed experimentation revealed the existence of a multilayered architecture within the film lining the alveoli. At the interface with the airspace exists a relatively rigid, saturated lipid-rich layer with mechanical stiffness, while underlying strata consist of softer, more fluid phases. This stratification is inherently dynamic, continuously disrupted by mechanical forces and gradually restored during intervals of shallow breathing. The researchers cleverly simulated these oscillations and tracked the evolution of surfactant layer composition over time, unveiling a delicate equilibrium poised between structure and function.

Deep breathing acts as a mechanical “reset” button, driving rearrangements within the surfactant film that enrich the outermost layer with saturated lipids, yielding a more densely packed interface. This state, although mechanically favorable, exists far from thermodynamic equilibrium and must be sustained through ongoing mechanical work—namely, the act of sighing or taking slow, deep breaths. This finding reshapes our understanding of the interplay between physical forces and biochemical composition, underscoring how physiological function is maintained by dynamic, nonequilibrium states rather than static material properties.

Clinically, these observations resonate with longstanding pulmonary care insights. It is well-documented that constant shallow breathing correlates with a steady decline in lung compliance, exacerbating respiratory difficulty in diseases and intensive care settings. The laboratory data mirror these clinical patterns, affirming that reduced mechanical perturbation correlates with surfactant layer disorganization and impaired lung mechanics. This convergence of empirical and clinical evidence compellingly validates the experimental model as a faithful representation of in vivo lung surfactant dynamics.

The translational implications of this research are profound. Recognizing the essential role of multilayered surfactant structures maintained by mechanical stimuli suggests novel therapeutic paradigms for adult lung injury. Rather than merely replenishing surfactant, future interventions might focus on components or formulations capable of reconstructing and sustaining these complex layered architectures. Vermant highlights nascent therapeutic strategies, including engineering surfactant-based foams, which hold promise in restoring lung compliance in ARDS patients by mimicking the mechanical and compositional heterogeneity observed in healthy pulmonary surfactant films.

Fundamentally, this multidisciplinary investigation bridges soft materials science, pulmonary physiology, and clinical medicine to elucidate a critical aspect of respiratory mechanics long shrouded in mystery. It reframes our understanding of sighing from a seemingly trivial reflex to a vital biomechanical process essential for maintaining lung health. By dissecting how mechanical forces sculpt surfactant structure and function, the study lays groundwork for pioneering treatments that could transform care for millions suffering from chronic and acute lung diseases globally.

As science continues to decode the biophysical intricacies of the lungs’ delicate interface with the atmosphere, such insights promise to inspire breakthroughs not only in pulmonary medicine but also in materials science, bioengineering, and beyond. The lungs, a marvel of evolutionary adaptation, depend on finely tuned mechanical-biochemical feedback loops, and it is only through cross-disciplinary research that we begin to fully grasp these subtle mechanisms. This study stands as a testament to the power of integrating experimental innovation with clinical relevance to unravel one of the most fundamental challenges in human health.

Subject of Research: Pulmonary surfactant mechanics and lung compliance dynamics

Article Title: How sighing regulates pulmonary surfactant structure and its role in breathing mechanics

News Publication Date: 24-Sep-2025

Web References:
https://www.science.org/doi/10.1126/sciadv.adx6034

References:
Novaes-Silva MC, Rodríguez-Hakim M, Thompson BR, Wagner NJ, Hermans E, Dupont LJ, Vermant J. How sighing regulates pulmonary surfactant structure and its role in breathing mechanics. Sci. Adv. (2025). DOI: 10.1126/sciadv.adx6034

Keywords: Pulmonary surfactant, respiratory distress syndrome, lung compliance, surface tension, alveoli, mechanical stress, deep breath, multilayered surfactant, acute respiratory distress syndrome, lung mechanics, soft materials, sighing

Surfactant replacement therapy has long been recognized as a cornerstone in the management of respiratory distress syndrome (RDS) in preterm newborns. Historically, surfactant administration has required endotracheal intubation and mechanical ventilation, invasive processes that, although lifesaving, expose fragile infants to ventilator-associated lung injury and other morbidities. The LISA technique circumvents these issues by delivering surfactant via a thin catheter during spontaneous breathing with continuous positive airway pressure (CPAP), thereby minimizing the trauma associated with intubation. This delicate balance between intervention and preservation represents a paradigm shift in neonatal care, promoting gentler respiratory support immediately after birth.

The team behind this initiative, Burris et al., embarked on a quality improvement project focusing on integrating LISA into the neonatal stabilization protocol within the delivery room environment. The goal was not only clinical efficacy but also workflow optimization for the multidisciplinary teams attending these vulnerable infants at birth. By strategically positioning surfactant delivery earlier in the care timeline, the study hypothesized that fewer infants would require subsequent intubation and invasive ventilation, parameters intimately associated with improved survival and reduced long-term pulmonary complications.

The methodology underlining this initiative was rigorous in design, employing real-time data analytics and standardized criteria for eligibility to receive LISA. Infants were continually monitored for respiratory parameters, oxygenation levels, and overall stability to ensure that the transition to this less invasive mode of surfactant delivery did not compromise safety. Additionally, training protocols for neonatologists, nurses, and respiratory therapists were meticulously developed to harmonize procedural consistency and expedite adoption. These elements combined to create a robust framework within which LISA could be seamlessly integrated into early neonatal care.

Results from this quality improvement initiative demonstrated a statistically significant reduction in the need for intubation among preterm infants treated with LISA in the delivery room setting. This outcome translates directly to decreased incidence of ventilator-associated complications and supports the broader movement toward non-invasive respiratory support in neonatology. Moreover, the quick application of surfactant immediately post-delivery leverages a critical window of pulmonary vulnerability, potentially mitigating the progression of RDS and facilitating more stable respiratory function in the earliest hours of life.

Beyond the immediate clinical advantages, the LISA approach exhibited organizational benefits by streamlining care delivery and reducing the complexity inherent in traditional surfactant administration protocols. By limiting invasive procedures in the delivery room, teams could focus on comprehensive stabilization efforts encompassing thermoregulation, infection prevention, and cardiovascular support. This holistic care model underscores how respiratory management improvements dovetail with broader neonatal quality initiatives, embodying an integrated strategy for optimizing infant outcomes.

The significance of the Burris et al. study is further amplified by its potential to alter clinical guidelines worldwide. Organizations such as the American Academy of Pediatrics and European consensus panels have long debated the balance between surfactant timing and method of administration. This work contributes a compelling data set advocating for earlier, less invasive interventions that align with evolving standards endorsing gentler ventilation strategies and minimizing iatrogenic injury. Its findings provide critical impetus for updating protocols in hospitals equipped to implement LISA, fostering a paradigm that prioritizes infant safety and developmental preservation.

From a physiological perspective, surfactants play an essential role in reducing alveolar surface tension, preventing atelectasis, and promoting efficient gas exchange. The delivery mechanics used in LISA leverage spontaneous breathing efforts, maintaining natural airway dynamics and potentially preserving surfactant distribution patterns more effectively than traditional intubation. This nuanced understanding of pulmonary physiology strengthens the rationale behind LISA, integrating clinical innovation with foundational respiratory science to optimize therapeutic effect in fragile neonatal lungs struggling to initiate aerobic respiration independently.

In terms of broader implications, reducing intubation rates through LISA could lead to downstream reductions in chronic lung disease incidence, neurodevelopmental impairment, and hospital length of stay, all of which carry profound economic and social consequences. Neonatal intensive care units worldwide face resource constraints, and minimizing invasive interventions can translate into cost savings, improved bed utilization, and enhanced family-centered care by allowing earlier transition to less intensive environments. Thus, the ripple effect of these findings extends beyond immediate clinical metrics to influence healthcare system sustainability and patient quality of life.

Implementing LISA within the delivery room does present challenges that this initiative astutely addressed. These include ensuring rapid decision-making under emergent circumstances, maintaining strict sterility, and equipping staff with the necessary skills to execute the technique efficiently without compromising other stabilization priorities. Burris et al. highlight the importance of interdisciplinary training and simulation-based preparation in overcoming these hurdles, emphasizing that successful LISA integration depends heavily on institutional culture and ongoing quality feedback mechanisms rather than purely technological capability.

Another critical dimension the study explores is parental involvement and communication. By minimizing invasive procedures at birth, healthcare providers can frame the stabilization process in a more reassuring manner, potentially alleviating parental anxiety during an already stressful experience. The less intimidating appearance of LISA compared to intubation fosters a perception of gentler care, which coupled with improved infant outcomes, can profoundly influence family satisfaction and trust in the healthcare team. This psychosocial benefit adds a compelling humanistic layer to the technical and clinical value of the study.

The study also reflects on the incremental nature of neonatal care innovation. While LISA has been increasingly adopted in various settings, embedding it as a standard delivery room intervention requires careful, staged integration supported by robust evidence and leadership buy-in. Burris et al. provide a replicable model of quality improvement methodology, illustrating how data-driven practice changes can be achieved in complex clinical environments without compromising patient safety or team dynamics. This strategic approach serves as a blueprint for institutions seeking to modernize neonatal respiratory support protocols sustainably and responsibly.

Furthermore, the initiative’s success is punctuated by meticulous outcome tracking beyond just immediate respiratory parameters. Secondary measures, including rates of bronchopulmonary dysplasia, intraventricular hemorrhage, and overall survival to discharge, were systematically analyzed to capture a comprehensive clinical picture. This multidimensional evaluation framework underscores the interdependence of physiological, neurological, and developmental outcomes in the neonatal period and bolsters confidence that LISA’s advantages extend well beyond short-term respiratory relief.

Concludingly, Burris et al. offer a persuasive argument for the widespread adoption of less invasive surfactant administration within the delivery room, positioning it as a pivotal advance in neonatal stabilization. Their quality improvement initiative not only validates LISA’s efficacy and safety but also highlights the transformative potential of integrating evidence-based respiratory interventions at the very onset of neonatal life. As neonatal care continues to evolve, approaches like LISA may well form the cornerstone of gentler, more effective management strategies that honor both the science and the humanity of caring for the most fragile patients.

This study’s implications beckon further exploration into refining delivery techniques, surfactant formulations, and supporting respiratory adjuncts that complement LISA’s effect. Future research can expand on population subsets, long-term neurodevelopmental outcomes, and cost-effectiveness analyses to cement its place within standard neonatal practice. As hospitals worldwide examine their own capabilities and protocols, the work of Burris and colleagues stands as a beacon, illuminating a path toward less invasive, more compassionate, and more effective neonatal respiratory care.

Subject of Research: Less invasive surfactant administration (LISA) in preterm infants to reduce intubation rates during neonatal stabilization in the delivery room.

Article Title: Less invasive surfactant administration in the delivery room: A quality improvement initiative.

Article References:
Burris, J.R., Germain, B.F., Chess, P.R. et al. Less invasive surfactant administration in the delivery room: A quality improvement initiative. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02350-w

Image Credits: AI Generated

DOI: https://doi.org/10.1038/s41372-025-02350-w