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Neonates and Preterm InfantsPhase 4SurfStab INCT07261787

Duration of Surfactant Administration and Impact on Stabilisation of Vital Parameters in Very Preterm Neonates: 1 Minutes Versus 5 Minutes

A Phase 4 study testing Poractant alfa (Curosurf®) - 1-minute administration and Poractant alfa (Curosurf®) - 5-minute administration in people with Neonates and Preterm Infants and Infant Respiratory Distress Syndrome, run by Medical University of Graz at 1 site in Austria.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Respiratory distress syndrome (RDS) is common in very preterm infants due to surfactant deficiency. Surfactant replacement therapy is lifesaving, and current guidelines recommend the less invasive surfactant administration (LISA) technique. Read more about this study

Who is it for?
Ages 0 months to 72 hours
What is being tested?
Poractant alfa (Curosurf®) - 1-minute administration and Poractant alfa (Curosurf®) - 5-minute administration
Could I receive a placebo?
No, everyone receives an active treatment
How many people
76 participants
Where
1 siteAustria
Study dates
20 Feb 2026to 1 Dec 2028
Phase
Phase 4
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 0 months to 72 hours
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Preterm neonate <28+0 weeks (gestational age up to 27 weeks and 6 days)
  • Indication of surfactant administration via the LISA method
  • Postnatal age < 72 hours

Who cannot join

  • Invasive ventilation, indication of INSURE procedure
  • Severe pulmonary or cardiac malformation affecting oxygenation or congenital cerebral malformation
  • Preexisiting diagnose of any IVH > grade 2 or PVH.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Christina H. Wolfsberger, Priv.Doz. DDr. contact

+43 316 385 81135

christina.wolfsberger@medunigraz.at

Gerhard Pichler, Univ.Prof. PD. Dr. contact

+43 316 385 80520

gerhard.pichler@medunigraz.at

Austria1 site, 1 recruiting
  • Medical University of Graz, Division of Neonatology, Department of Pediatrics and Adolescent Medicine

    Graz, 8036

    Recruiting

Other trials in Austria

About this study

Official title: Duration of Surfactant Administration and Impact on Stabilisation of Vital Parameters in Very Preterm Neonates: 1 Minute Versus 5 Minutes - a Prospective Randomised-controlled Phase IV Trial - A Randomised Clinical Trial on Influence of Duration of Surfactant Administration on Stabilisation of Routine Monitoring Parameters and Cerebral Tissue Oxygen Saturation Monitoring in Preterm Neonates < 28 Weeks of Gestational Age

Respiratory distress syndrome (RDS) is common in very preterm infants due to surfactant deficiency. Surfactant replacement therapy is lifesaving, and current guidelines recommend the less invasive surfactant administration (LISA) technique. However, the optimal duration of surfactant instillation during LISA has never been systematically evaluated. Rapid instillation may provoke transient hypoxia and bradycardia, while slower administration might improve physiological stability and cerebral oxygenation.

This randomised controlled trial investigates whether the duration of surfactant administration (1 minute versus 5 minutes) affects cerebral and systemic oxygen stability in extremely preterm neonates (< 28 weeks).

Read the detailed description

The SurfStab I Trial is a single-centre, randomised, controlled, phase IV trial conducted at the Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Austria.

Infants born before 28 weeks of gestation and requiring surfactant therapy via the LISA technique will be randomised (1:1) to receive poractant alfa administered over either 1 minute or 5 minutes. The intervention duration represents two clinically accepted timeframes within current guideline recommendations.

Cerebral oxygenation will be monitored continuously using near-infrared spectroscopy (NIRS) from 5 minutes before to 3 hours after the procedure. The primary outcome is the maximal change in cerebral regional tissue oxygen saturation (crSO₂) from baseline (=5 minutes before starting the LISA procedure [insertion of the LISA catheter]) till 15 minutes after the LISA procedure (=removal of the LISA catheter). Secondary outcomes include changes in peripheral oxygen saturation (SpO₂), heart rate (HR), mean arterial blood pressure (MABP), frequency and duration of hypoxic or bradycardic episodes, and the need for repeated surfactant administration or invasive ventilation.

The total sample size is 76 infants (38 per arm). The study will provide evidence on whether slower surfactant administration improves physiological stability and cerebral oxygenation.

Being tested
Poractant alfa (Curosurf®) - 1-minute administration, Poractant alfa (Curosurf®) - 5-minute administration
Keywords
surfactant, surfactant administration, LISA, less-invasive surfactant administration, preterm neonates, cerebral oxygenation, near-infrared spectroscopy
Medical subject headings
Pulmonary Atelectasis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Poractant alfa (Curosurf®) - 1-minute administrationDrug

    Poractant alfa (Curosurf®, Chiesi Pharmaceuticals) administered intratracheally via the Less Invasive Surfactant Administration (LISA) technique over 1 minute.

    The surfactant is instilled manually through a thin catheter under direct laryngoscopy while the infant remains on continuous positive airway pressure (CPAP) and spontaneous breathing.

    Pre-specified criteria for aborting the LISA procedure are prolonged bradycardia (HR < 80 bpm) and/or arterial hypoxia (SpO2 < 80%) over 60 seconds during surfactant administration starting after the instillation of the LISA catheter. Data of included participants with discontinuation will be collected and analysed.

  • Poractant alfa (Curosurf®) - 5-minute administrationDrug

    Poractant alfa (Curosurf®, Chiesi Pharmaceuticals) administered intratracheally via the Less Invasive Surfactant Administration (LISA) technique over 5 minute.

    The surfactant is instilled manually through a thin catheter under direct laryngoscopy while the infant remains on continuous positive airway pressure (CPAP) and spontaneous breathing.

    Pre-specified criteria for aborting the LISA procedure are prolonged bradycardia (HR < 80 bpm) and/or arterial hypoxia (SpO2 < 80%) over 60 seconds during surfactant administration starting after the instillation of the LISA catheter. Data of included participants with discontinuation will be collected and analysed.

Study groups in NCT07261787
Study groupRoleWhat they receive
1-Minute Administration ("1-min"-group)ExperimentalInfants receive poractant alfa (Curosurf®) administered via the LISA technique over 1 minute.
Receives: Drug: Poractant alfa (Curosurf®) - 1-minute administration
5-Minute Administration ("5-min"-group)ExperimentalInfants receive poractant alfa (Curosurf®) administered via the LISA technique over 5 minutes.
Receives: Drug: Poractant alfa (Curosurf®) - 5-minute administration

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in cerebral oxygenation (crSO₂) during and after LISA

    The primary outcome measure will be the maximum change of crSO2 from baseline till the end of the primary window (=duration of LISA administration + 15 minutes after removal of the thin catheter). Mean values of crSO2 during the 5min before intervention started is defined as the baseline. crSO2 parameters with beginning five minute before surfactant administration till 15 minutes after extubating will be assessed every minute.

    Measured: From baseline (= 5min before insertion of the LISA catheter) till 15 minutes after removal of the thin catheter

Secondary outcomes (18)
  1. Change in arterial oxygen saturation (SpO₂) during and after LISA

    The secondary outcome measure will be the maximum change of SpO2 from baseline till the end of the primary window (=duration of LISA administration + 15 minutes after removal of the thin catheter). Mean values of SpO2 during the 5min before intervention started is defined as the baseline. SpO2 parameters with beginning five minute before surfactant administration till 15 minutes after extubating will be assessed every minute.

    Measured: From baseline (= 5min before insertion of the LISA catheter) till 15 minutes after removal of the thin catheter

  2. Change in heart rate (HR) during and after LISA

    The secondary outcome measure will be the maximum change of HR from baseline till the end of the primary window (=duration of LISA administration + 15 minutes after removal of the thin catheter). Mean values of HR during the 5min before intervention started is defined as the baseline. HR parameters with beginning five minute before surfactant administration till 15 minutes after extubating will be assessed every minute.

    Measured: From baseline (= 5min before insertion of the LISA catheter) till 15 minutes after removal of the thin catheter

  3. Change in crSO2 up to three hours after LISA

    The secondary outcome measures will be crSO2 up to three hours after surfactant administration defined as maximum changes/drop from starting with the beginning of the surfactant administration after insertion of the thin catheter till three hours after LISA procedure. Vital parameters will be assessed every five minutes till three hours after LISA procedure.

    Measured: Beginning of the surfactant administration (insertion of the thin catheter) till three hours after LISA procedure

  4. Change in SpO2 up to three hours after LISA

    The secondary outcome measures will be SpO2 up to three hours after surfactant administration defined as maximum changes/drop from starting with the beginning of the surfactant administration after insertion of the thin catheter till three hours after LISA procedure. Vital parameters will be assessed every five minutes till three hours after LISA procedure.

    Measured: Beginning of the surfactant administration (insertion of the thin catheter) till three hours after LISA procedure

  5. Change in HR up to three hours after LISA

    The secondary outcome measures will be HR up to three hours after surfactant administration defined as maximum changes/drop from starting with the beginning of the surfactant administration after insertion of the thin catheter till three hours after LISA procedure. Vital parameters will be assessed every five minutes till three hours after LISA procedure.

    Measured: Beginning of the surfactant administration (insertion of the thin catheter) till three hours after LISA procedure

  6. Change in mean arterial blood pressure (MABP) up to three hours after LISA

    The secondary outcome measures will be MABP up to three hours after surfactant administration defined as maximum changes/drop from starting with the beginning of the surfactant administration after insertion of the thin catheter till three hours after LISA procedure. Vital parameters will be assessed every five minutes till three hours after LISA procedure.

    Measured: Beginning of the surfactant administration (insertion of the thin catheter) till three hours after LISA procedure

  7. Amount of bradycardia

    The secondary outcome measure will be the amount of bradycardia (in minutes) up to three hours after surfactant administration

    Measured: Beginning of the surfactant administration (insertion of the thin catheter) till three hours after LISA procedure

  8. Amount of cerebral hypoxia

    The secondary outcome measure will be the amount of cerebral hypoxia (in minutes) up to three hours after surfactant administration

    Measured: Beginning of the surfactant administration (insertion of the thin catheter) till three hours after LISA procedure

  9. Amount of systemic hypoxia

    The secondary outcome measure will be the amount of systemic hypoxia (in minutes) up to three hours after surfactant administration

    Measured: Beginning of the surfactant administration (insertion of the thin catheter) till three hours after LISA procedure

  10. Amount of supplemental oxygen

    The secondary outcome measure will be the amount of supplemental oxygen up to three hours after surfactant administration

    Measured: Beginning of the surfactant administration (insertion of the thin catheter) till three hours after LISA procedure

  11. Need for repeat surfactant administraiton

    Proportion of infants requiring a second surfactant dose as per clinical indication.

    Measured: Within 48 hours after first LISA procedure

  12. Need for invasive ventilation

    Proportion of infants requiring intubation and mechanical ventilation due to respiratory failure.

    Measured: Within 48 hours after first LISA procedure

  13. Bronchopulmonary dysplasia (BPD)

    Incidence of BPD, defined as oxygen and/or respiratory support requirement at 36 weeks postmenstrual age.

    Measured: At 36 weeks corrected gestational age

  14. Intraventricular haemorrhage (IVH)

    Incidence of any IVH assessed by cranial ultrasound

    Measured: At 40 weeks of corrected age

  15. Periventricular leukomalacia (PVL)

    Presence of cystic PVL or increased periventricular echogenicity consistent with white matter injury.

    Measured: At 40 weeks of corrected age

  16. Retinopathy of prematurity

    Presence of ROP

    Measured: At 40 weeks of corrected age

  17. Necrotizing enterocolitis (NEC)

    Presence of NEC

    Measured: At 40 weeks of corrected age

  18. Mortality

    Occurence of mortality during hospital stay

    Measured: At 40 weeks of corrected age

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Dec 2025
  2. Study start20 Feb 2026
  3. Primary completion1 Jul 2028 (estimated)
  4. Study completion1 Dec 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
76 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07261787
Sponsor's protocol ID
SurfStab I Trial
Other IDs
2025-522754-39-00, 2025
Acronym
SurfStab I
Status last verified
May 2026
First submitted
14 Nov 2025
Last updated
14 May 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual participant data will not be shared because the study population consists of extremely preterm neonates, and complete anonymisation cannot be guaranteed due to the small sample size and highly specific physiological datasets (continuous cerebral and systemic oxygenation monitoring). Sharing such detailed physiological and clinical data could potentially allow re-identification of individual participants, even after de-identification. In addition, the national ethics approval and parental consent cover data use exclusively for the present research project and associated publications, not for open data sharing. Aggregated and summarised results will, however, be made publicly available through peer-reviewed publications and trial registries upon study completion.

Publications

  • Wolfsberger CH, Schwaberger B, Baik-Schneditz N, Avian A, Holter M, Pichler G. Duration of surfactant administration and its impact on stabilisation of vital parameters in very preterm neonates <28 weeks of gestational age (SurfStab): 1 min versus 5 min-study protocol for a prospective randomised-controlled phase IV trial. Front Pediatr. 2026 Sep 30;14:1939771. doi: 10.3389/fped.2026.1939771. eCollection 2026.

    PubMed 42877269

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Poractant alfa (Curosurf®) - 1-minute administration and Poractant alfa (Curosurf®) - 5-minute administration in people with Neonates and Preterm Infants and Infant Respiratory Distress Syndrome, run by Medical University of Graz at 1 site in Austria.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 14 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Austria. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Christina H. Wolfsberger, Priv.Doz. DDr. (+43 316 385 81135, christina.wolfsberger@medunigraz.at), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in cerebral oxygenation (crSO₂) during and after LISA (time frame: From baseline (= 5min before insertion of the LISA catheter) till 15 minutes after removal of the thin catheter). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07261787, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 May 2026.

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