Comparison of Outcomes of Less Invasive Surfactant Administration in Prematurely Born Infants in the Delivery Suite and the Neonatal Unit

Abstract

Objective This study aimed to compare outcomes of infants who received less invasive surfactant administration (LISA) in the delivery suite (LISA-DS) with those who received LISA on the neonatal unit (LISA-NNU).

Study Design A prospective cohort study was undertaken of all infants who received LISA in a single center. Clinical outcomes included admission temperature, the need for intubation, durations of invasive and noninvasive ventilation, length of hospital stay and the incidences of bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and requirement for home oxygen were compared between the two groups as were complications of the procedure.

Results The 54 LISA-DS infants had similar gestational ages and birth weights to the 26 LISA-NNU infants (p = 0.732, 0.928, respectively). There were no significant differences between the admission temperatures (median [range]: 36.8 [36–38.7] vs. 36.8°C [36.4–37.7]; p = 0.451) or need for intubation in less than 72 hours of birth (28 vs. 23%, p = 0.656). The durations of invasive ventilation (median: 2 [0–65] vs. 1 [0–35] days; p = 0.188) and noninvasive ventilation (median: 37 [24–81] vs. 37 [3–225] days; p = 0.188) and the incidences of BPD (p = 0.818), IVH (p = 0.106), ROP (p = 0.526), and home oxygen requirement (p = 0.764) were similar. The percentage of successful first attempts with LISA (63 vs. 70%, p = 0.816) or associated with hypoxia episodes (32 vs. 42%, p = 0.194) did not differ significantly by site of administration.

Conclusion The outcomes of LISA performed on the DS were similar to those of LISA performed on the NNU.

Key Points

• Prematurely born infants who received LISA in the DS had comparable clinical outcomes to infants who received LISA on NNU.

• No significant differences in admission temperature was noticed in infants who received LISA, in DS versus NNU.

Keywords

LISA - surfactant administration - admission temperature - duration of mechanical ventilation - length of hospital stay

Authors' Contributions

S.S. and A.G. designed the study. D.T. collected the data. S.S., D.D., and A.K. designed the statistical analysis and analyzed the data and approved the final manuscript as submitted. All authors were involved in the preparation of the manuscript and approved the final manuscript as submitted.

Ethical Approval

This project was registered as an audit with St George's University Hospitals NHS Foundation Trust Audit Department.

Publication History

Received: 09 April 2023

Accepted: 26 May 2023

Accepted Manuscript online:
27 July 2023

Article published online:
24 August 2023

• References

• 1 Aldana-Aguirre JC, Pinto M, Featherstone RM, Kumar M. Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2017; 102 (01) F17-F23
• 2 Sweet DG, Carnielli V, Greisen G. et al. European Consensus Guidelines on the management of respiratory distress syndrome - 2019 update. Neonatology 2019; 115 (04) 432-450
• 3 Lau CSM, Chamberlain RS, Sun S. Less invasive surfactant administration reduces the need for mechanical ventilation in preterm infants: a meta-analysis. Glob Pediatr Health 2017;4:2333794 × 17696683
• 4 Klotz D, Porcaro U, Fleck T, Fuchs H. European perspective on less invasive surfactant administration-a survey. Eur J Pediatr 2017; 176 (02) 147-154
• 5 Jeffreys E, Hunt K, Dassios T, Greenough A. UK survey of less invasive surfactant administration. Arch Dis Child Fetal Neonatal Ed 2019; 104 (05) F567
• 6 Bhayat S, Kaur A, Premadeva I, Reynolds P, Gowda H. Survey of less invasive surfactant administration in England, slow adoption and variable practice. Acta Paediatr 2020; 109 (03) 505-510
• 7 Arattu Thodika FMS, Ambulkar H, Williams E, Bhat R, Dassios T, Greenough A. Outcomes following less-invasive-surfactant-administration in the delivery-room. Early Hum Dev 2022; 167: 105562
• 8 Balazs G, Balajthy A, Riszter M. et al. Incidence, predictors of success and outcome of LISA in very preterm infants. Pediatr Pulmonol 2022; 57 (07) 1751-1759
• 9 Laptook AR, Bell EF, Shankaran S. et al; Generic and Moderate Preterm Subcommittees of the NICHD Neonatal Research Network. Admission temperature and associated mortality and morbidity among moderately and extremely preterm infants. J Pediatr 2018; 192: 53-59.e2
• 10 Miller SS, Lee HC, Gould JB. Hypothermia in very low birth weight infants: distribution, risk factors and outcomes. J Perinatol 2011; 31 (Suppl. 01) S49-S56
• 11 Lyu Y, Shah PS, Ye XY. et al; Canadian Neonatal Network. Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks' gestation. JAMA Pediatr 2015; 169 (04) e150277
• 12 Shetty S, Egan H, Cornuaud P, Kulkarni A, Duffy D, Greenough A. Less invasive surfactant administration in very prematurely born infants. AJP Rep 2021; 11 (03) e119-e122
• 13 Liebers B, Ebenebe CU, Wolf M. et al. Improved less invasive surfactant administration success in preterm infants after procedure standardization. Children (Basel) 2021; 8 (12) 1145
• 14 Laptook AR, Salhab W, Bhaskar B. Neonatal Research Network. Admission temperature of low birth weight infants: predictors and associated morbidities. Pediatrics 2007; 119 (03) e643-e649
• 15 Abdel-Latif ME, Davis PG, Wheeler KI, De Paoli AG, Dargaville PA. Surfactant therapy via thin catheter in preterm infants with or at risk of respiratory distress syndrome. Cochrane Database Syst Rev 2021; 5 (05) CD011672
• 16 Kribs A, Roll C, Göpel W. et al; NINSAPP Trial Investigators. Nonintubated surfactant application vs conventional therapy in extremely preterm infants: a randomized clinical trial. JAMA Pediatr 2015; 169 (08) 723-730
• 17 Isayama T, Iwami H, McDonald S, Beyene J. Association of noninvasive ventilation strategies with mortality and bronchopulmonary dysplasia among preterm infants: a systematic review and meta-analysis. JAMA 2016; 316 (06) 611-624
• 18 Dekker J, Lopriore E, van Zanten HA, Tan RNGB, Hooper SB, Te Pas AB. Sedation during minimal invasive surfactant therapy: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2019; 104 (04) F378-F383
• 19 Borenstein-Levin L, Synnes A, Grunau RE, Miller SP, Yoon EW, Shah PS. Canadian Neonatal Network Investigators. Narcotics and sedative use in preterm neonates. J Pediatr 2017; 180: 92-98.e1