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Background Less invasive surfactant administration (LISA) is the preferred mode of surfactant administration for spontaneously breathing preterm babies supported by noninvasive ventilation (NIV).  Objective The aim of this study was to determine whether LISA on the neonatal unit or in the delivery suite was associated with reduced rates of bronchopulmonary dysplasia (BPD) or the need for intubation, or lower durations of invasive ventilation and length of hospital stay (LOS).  Methods A historical comparison was undertaken. Each “LISA” infant was matched with two infants (controls) who did not receive LISA.  Results The 25 LISA infants had similar gestational ages and birth weights to the 50 controls (28 [25.6–31.7] weeks vs. 28.5 [25.4–31.9] weeks, p = 0.732; 1,120 (580–1,810) g vs. 1,070 [540–1,869] g, p = 0.928), respectively. LISA infants had lower requirement for intubation (52 vs. 90%, p &lt; 0.001), shorter duration of invasive ventilation (median 1 [0–35] days vs. 6 [0–62] days p = 0.001) and a lower incidence of BPD (36 vs. 64%, p = 0.022). There were no significant differences in duration of NIV (median 26 [3–225] vs. 23 [2–85] days, p = 0.831) or the total LOS (median 76 [24–259] vs. 85 [27–221], p = 0.238).  Conclusion LISA on the neonatal unit or the delivery suite was associated with a lower BPD incidence, need for intubation, and duration of invasive ventilation.

Less Invasive Surfactant Administration in Very Prematurely Born Infants