Less Invasive Surfactant Administration in Very Prematurely Born Infants

Abstract 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 < 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.

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Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants

Acta Paediatrica ◽

10.1111/apa.12883 ◽

2015 ◽

Vol 104 (3) ◽

pp. 241-246 ◽

Cited By ~ 53

Author(s):

Wolfgang Göpel ◽

Angela Kribs ◽

Christoph Härtel ◽

Stefan Avenarius ◽

Norbert Teig ◽

...

Keyword(s):

Preterm Infants ◽

Less Invasive ◽

Surfactant Administration ◽

Spontaneously Breathing

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The Miracles of Surfactant: Less Invasive Surfactant Administration, Nebulization, and Carrier of Topical Drugs

Neonatology ◽

10.1159/000516106 ◽

2021 ◽

pp. 1-10

Author(s):

Christoph Härtel ◽

Kirsten Glaser ◽

Christian P. Speer

Keyword(s):

Replacement Therapy ◽

Preterm Infants ◽

Invasive Mechanical Ventilation ◽

Lung Surfactant ◽

Standard Of Care ◽

Less Invasive ◽

Surfactant Replacement Therapy ◽

Surfactant Administration ◽

Invasive Techniques ◽

Spontaneously Breathing

Surfactant replacement therapy (SRT) has long become the standard of care in the treatment of neonatal respiratory distress syndrome (RDS), significantly decreasing acute pulmonary morbidity and mortality in preterm infants. For decades, this beneficial replacement therapy has been administered via endotracheal tube. Despite significantly improving the outcome of RDS, however, the burden of bronchopulmonary dysplasia remains, in particular, in very immature preterm infants. Acknowledging the direct relationship between exposure to and duration of invasive mechanical ventilation and chronic lung disease, the latter has been gradually replaced by noninvasive ventilation strategies in neonatal RDS. This replacement is strongly related to the demand for similarly noninvasive modes of surfactant administration. Alternative techniques in spontaneously breathing infants have evolved, including less invasive techniques using thin catheters (less invasive surfactant administration and minimally invasive surfactant treatment) as well as nebulization of surfactant, although the latter is not ready for clinical application yet. In addition, given their therapeutic delivery to the lungs and subsequent alveolar distribution, surfactant preparations represent an attractive vehicle for pulmonary deposition of drugs in preterm infants. Further improvement of SRT and expansion of the field of application of lung surfactant may hold additional benefits, especially in the treatment of the most immature preterm infants.

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Effects of less-invasive surfactant administration on oxygenation, pulmonary surfactant distribution, and lung compliance in spontaneously breathing preterm lambs

Pediatric Research ◽

10.1038/pr.2014.66 ◽

2014 ◽

Vol 76 (2) ◽

pp. 166-170 ◽

Cited By ~ 26

Author(s):

Hendrik J. Niemarkt ◽

Elke Kuypers ◽

Reint Jellema ◽

Daan Ophelders ◽

Matthias Hütten ◽

...

Keyword(s):

Pulmonary Surfactant ◽

Lung Compliance ◽

Less Invasive ◽

Surfactant Administration ◽

Spontaneously Breathing

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Implementing less invasive surfactant administration on a neonatal unit

Archives of Disease in Childhood - Education and Practice ◽

10.1136/archdischild-2020-320574 ◽

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.

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