scholarly journals Two-year outcome data suggest that less invasive surfactant administration (LISA) is safe. Results from the follow-up of the randomized controlled AMV (avoid mechanical ventilation) study

2020 ◽  
Vol 179 (8) ◽  
pp. 1309-1313 ◽  
Author(s):  
Egbert Herting ◽  
◽  
Angela Kribs ◽  
Christoph Härtel ◽  
Axel von der Wense ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Outcome Data ◽  
Less Invasive ◽  
Randomized Controlled ◽  
Surfactant Administration

Comparison Between Less Invasive Surfactant Administration (LISA) and Intubation-Surfactant-Extubation (InSurE) in Preterm Infants with Respiratory Distress Syndrome: A Retrospective Study

2020 ◽  
Author(s):  
Sungmin Yang ◽  
Yong Hyuk Kim ◽  
Byoung Kook Lee
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Study ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Distress Syndrome ◽  
Saturation Index ◽  
Invasive Mechanical Ventilation ◽  
Less Invasive ◽  
Surfactant Administration

Abstract Background: Bronchopulmonary dysplasia (BPD) is an important morbidity caused by neonatal lung injury due to mechanical ventilator use. Respiratory distress syndrome (RDS) is leading cause of mechanical ventilation in preterm infants. Surfactant was administrated through the endotracheal tube for management of RDS, which compels invasive mechanical ventilation. Recently, Intubation-SURfactant administration-Extubation (INSURE) and Less-invasive surfactant administration (LISA) have been introduced to avoid invasive mechanical ventilation. This study aimed to compare the effectiveness of LISA and INSURE.Methods: This single-center, retrospective study enrolled 47 newborns admitted to the neonatal intensive care unit (NICU) of the Wonju Severance Christian’s Hospital between January 1, 2017 and August 31, 2019, above a gestational age of 25 weeks, and required surfactant. The patient were divided into the LISA group and the INSURE group, and compared capillary gas analysis, oxygen saturation index (OSI), and morbidities.Results: The LISA group and the INSURE group included 34 and 13 newborns respectively. Demographic feature and OSI showed no significant differences between two groups. In the LISA group, pCO2 decreased over 1 hour(57.49±9.43mmHg), 2 hours(53.07±9.25mmHg, p=0.04) and 6 hours (46.50±8.53mmHg, p=0.01). pCO2 of the INSURE group decreased steeper within 2 hours (49.55±8.96mmHg to 39.56±6.20mmHg) in the INSURE group, however, the trend was not significant (p = 0.06). There were no significant differences in morbidities. Discussion: LISA and INSURE showed no significant differences in OSI and morbidities. Although LISA decreases pCO2 more slowly than INSURE, the difference is not statistical significant. LISA and INSURE are equally effective modalities for surfactant administration.

scholarly journals Introducing Less-Invasive Surfactant Administration into a Level IV NICU: A Quality Improvement Initiative

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 580
Author(s):  
Steven M. Conlon ◽  
Allison Osborne ◽  
Julie Bodie ◽  
Jaime Marasch ◽  
Rita M. Ryan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Quality Improvement ◽  
Literature Review ◽  
Gestational Age ◽  
Simulation Training ◽  
Project Planning ◽  
Quality Improvement Initiative ◽  
Less Invasive ◽  
The Us ◽  
Surfactant Administration

Less-invasive surfactant administration (LISA), a newer technique of delivering surfactant via a thin catheter, avoids mechanical ventilation. LISA has been widely adopted in Europe but less so in the US. Our goal was to increase the percentage of surfactant delivered via LISA from 0% to 51% by 12/2020. Project planning and literature review started 12/2019, and included a standardized equipment kit and simulation training sessions. We began Plan–Do–Study–Act (PDSA) cycles in 6/2020. Initial exclusions for LISA were gestational age (GA) <28 weeks (w) or ≥36 w, intubation in the delivery room, or PCO2 >70 if known; GA exclusion is now <25 w. From 6 to 12/2020, 97 patients received surfactant, 35 (36%) via LISA. When non-LISA-eligible patients were excluded, 35/42 (83%) received LISA successfully. There were only 2/37 patients for whom LISA was not able to be performed. Three LISA infants required mechanical ventilation in the first week of life. Sedation remained an initial challenge but improved when sucrose was used routinely. LISA was safely and successfully introduced in our NICU.

Implementing less invasive surfactant administration on a neonatal unit

2021 ◽  
pp. edpract-2020-320574
Author(s):  
Sarah Louise Williamson ◽  
Helen McDermott ◽  
Harsha Gowda
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Neonatal Intensive Care ◽  
Optimal Method ◽  
Improvement Project ◽  
Less Invasive ◽  
European Guidelines ◽  
Surfactant Administration ◽  
Barriers And Challenges ◽  
Spontaneously Breathing

There is increasing evidence reflected in both UK 2019 NICE and European guidelines suggesting that less invasive surfactant administration (LISA) reduces the need for mechanical ventilation and reduces the combined outcome of death or bronchopulmonary dysplasia, and is now the optimal method for surfactant delivery in spontaneously breathing babies. Despite this, uptake in England has been slow compared with Europe. This quality improvement project outlines the process of implementing LISA in a neonatal intensive care unit over a 2-year period, the barriers and challenges which were encountered, and how they were overcome.

scholarly journals Traditional Mongolian swaddling and developmental dysplasia of the hip: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Munkhtulga Ulziibat ◽  
Bayalag Munkhuu ◽  
Ariun-Erdene Bataa ◽  
Raoul Schmid ◽  
Thomas Baumann ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Outcome Data ◽  
Developmental Dysplasia ◽  
Monthly Basis ◽  
Randomized Controlled ◽  
Dysplasia Of The Hip

Abstract Background Mongolian traditional swaddling of infants, where arms and legs are extended with a tight wrapping and hips are in adduction position, may lead to abnormal maturation and formation of the hip joint; and is a contributing factor for developmental dysplasia of the hip (DDH). This hypothesis was tested in this randomized controlled trial. Methods Eighty newborns with one or two hips at risk of worsening to DDH (Graf Type 2a; physiologically immature hips) at birth were randomized into 2 groups at a tertiary hospital in Ulaanbaatar. The “swaddling” group (n = 40) was swaddled in the common traditional Mongolian method for a month while the “non-swaddling” group (n = 40) was instructed not to swaddle at all. All enrollees were followed up on monthly basis by hip ultrasound and treated with an abduction-flexion splint if necessary. The groups were compared on the rate of Graf’s “non-Type 1” hips at follow-up controls as the primary outcome. Secondary outcomes were rate of DDH and time to discharge (Graf Type 1; healthy hips). In addition, correlation between the primary outcome and swaddling length in days and frequency of swaddling in hours per day were calculated. Results Recruitment continued from September 2019 to March 2020 and follow-up data were completed in June 2020. We collected final outcome data in all 80 enrollees. Percentages of cases with non-Type 1 hip at any follow-up examination were 7.5% (3/40) in the non-swaddling group and 40% (16/40) in the swaddling group (p = 0.001). There was no DDH case in the non-swaddling group while there were 8 cases of DDH in the swaddling group. The mean time to discharge was 5.1 ± 0.3 weeks in the non-swaddling group and 8.4 ± 0.89 weeks in the swaddling group (p = 0.001). There is a correlation between the primary outcome and the swaddling frequency in hours per day (r = 0.81) and swaddling length in days (r = 0.43). Conclusions Mongolian traditional swaddling where legs are extended and hips are in extension and adduction position increases the risk for DDH. Trial registration Retrospectively registered, ISRCTN11228572.

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