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

Overview

Journal Am J Perinatol

Specialty Gynecology & Obstetrics

Date 2023 Jul 27

PMID 37500076

Authors

Sandeep Shetty

Donna Tolentino

Anay Kulkarni

Donovan Duffy

Anne Greenough

Affiliations

Soon will be listed here.

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 ( = 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]; = 0.451) or need for intubation in less than 72 hours of birth (28 vs. 23%, = 0.656). The durations of invasive ventilation (median: 2 [0-65] vs. 1 [0-35] days; = 0.188) and noninvasive ventilation (median: 37 [24-81] vs. 37 [3-225] days; = 0.188) and the incidences of BPD ( = 0.818), IVH ( = 0.106), ROP ( = 0.526), and home oxygen requirement ( = 0.764) were similar. The percentage of successful first attempts with LISA (63 vs. 70%, = 0.816) or associated with hypoxia episodes (32 vs. 42%, = 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..

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References

Kribs A, Roll C, Gopel W, Wieg C, Groneck P, Laux R . Nonintubated Surfactant Application vs Conventional Therapy in Extremely Preterm Infants: A Randomized Clinical Trial. JAMA Pediatr. 2015; 169(8):723-30. DOI: 10.1001/jamapediatrics.2015.0504. View

Dekker J, Lopriore E, van Zanten H, Tan R, Hooper S, Te Pas A . Sedation during minimal invasive surfactant therapy: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2018; 104(4):F378-F383. DOI: 10.1136/archdischild-2018-315015. View

Arattu Thodika F, 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. DOI: 10.1016/j.earlhumdev.2022.105562. View

Lau C, Chamberlain R, Sun S . Less Invasive Surfactant Administration Reduces the Need for Mechanical Ventilation in Preterm Infants: A Meta-Analysis. Glob Pediatr Health. 2017; 4:2333794X17696683. PMC: 5433666. DOI: 10.1177/2333794X17696683. View

Borenstein-Levin L, Synnes A, Grunau R, Miller S, Yoon E, Shah P . Narcotics and Sedative Use in Preterm Neonates. J Pediatr. 2016; 180:92-98.e1. DOI: 10.1016/j.jpeds.2016.08.031. View

Liebers B, Ebenebe C, Wolf M, Blohm M, Vettorazzi E, Singer D . Improved Less Invasive Surfactant Administration Success in Preterm Infants after Procedure Standardization. Children (Basel). 2021; 8(12). PMC: 8700472. DOI: 10.3390/children8121145. View

Laptook A, Bell E, Shankaran S, Boghossian N, Wyckoff M, Kandefer S . Admission Temperature and Associated Mortality and Morbidity among Moderately and Extremely Preterm Infants. J Pediatr. 2017; 192:53-59.e2. PMC: 5808888. DOI: 10.1016/j.jpeds.2017.09.021. View

Miller S, Lee H, Gould J . Hypothermia in very low birth weight infants: distribution, risk factors and outcomes. J Perinatol. 2011; 31 Suppl 1:S49-56. DOI: 10.1038/jp.2010.177. View

Aldana-Aguirre J, Pinto M, Featherstone R, 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. 2016; 102(1):F17-F23. DOI: 10.1136/archdischild-2015-310299. View

10.

Lyu Y, Shah P, Ye X, Warre R, Piedboeuf B, Deshpandey A . Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks' gestation. JAMA Pediatr. 2015; 169(4):e150277. DOI: 10.1001/jamapediatrics.2015.0277. View

11.

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(3):e119-e122. PMC: 8458038. DOI: 10.1055/s-0041-1735632. View

12.

Jeffreys E, Hunt K, Dassios T, Greenough A . UK survey of less invasive surfactant administration. Arch Dis Child Fetal Neonatal Ed. 2019; 104(5):F567. DOI: 10.1136/archdischild-2018-316466. View

13.

Balazs G, Balajthy A, Riszter M, Kovacs T, Szabo T, Belteki G . Incidence, predictors of success and outcome of LISA in very preterm infants. Pediatr Pulmonol. 2021; 57(7):1751-1759. PMC: 9325361. DOI: 10.1002/ppul.25798. View

14.

Klotz D, Porcaro U, Fleck T, Fuchs H . European perspective on less invasive surfactant administration-a survey. Eur J Pediatr. 2016; 176(2):147-154. DOI: 10.1007/s00431-016-2812-9. View

15.

Abdel-Latif M, Davis P, Wheeler K, De Paoli A, Dargaville P . Surfactant therapy via thin catheter in preterm infants with or at risk of respiratory distress syndrome. Cochrane Database Syst Rev. 2021; 5:CD011672. PMC: 8109227. DOI: 10.1002/14651858.CD011672.pub2. View

16.

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(6):611-24. DOI: 10.1001/jama.2016.10708. View

17.

Sweet D, Carnielli V, Greisen G, Hallman M, Ozek E, Te Pas A . European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2019 Update. Neonatology. 2019; 115(4):432-450. PMC: 6604659. DOI: 10.1159/000499361. View

18.

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. 2019; 109(3):505-510. DOI: 10.1111/apa.14995. View

19.

Laptook A, Salhab W, Bhaskar B . Admission temperature of low birth weight infants: predictors and associated morbidities. Pediatrics. 2007; 119(3):e643-9. DOI: 10.1542/peds.2006-0943. View