573 Helping babies breathe: describing our experiences of introducing less invasive surfactant administration to reduce rates of bronchopulmonary dysplasia

Abstract

<h3>Background</h3> Respiratory Distress Syndrome affects approximately 50% of babies born under 32 weeks gestation. Surfactant is a key component in reducing surface lung tension, and despite the administration of antenatal steroids to mothers at risk of preterm delivery to promote surfactant production, many preterm babies are born with surfactant deficiency. If left untreated babies require increasing respiratory support, and potential complications such as pneumothorax, the development of bronchopulmonary dysplasia, home oxygen and increased susceptibility to infections. Traditionally surfactant administration requires babies to be intubated and placed on mechanical ventilation. With this technique there are many potential complications, including the use of drugs for sedation during intubation, the risk of trauma and subsequent airway abnormalities, and the risk of barotrauma to the lungs due to persistent use of high pressure ventilation. <h3>Objectives</h3> Less invasive surfactant administration (LISA) delivers surfactant directly to the lungs via a tracheal fine-bore catheter avoiding invasive ventilation. Following introduction into our unit in May 2018 we determined LISA efficacy by comparing total ventilation days, total non-invasive ventilation days, total oxygen days and bronchopulmonary dysplasia rates between babies who received surfactant via LISA to those following intubation. <h3>Methods</h3> Between May 2018 and October 2019 89 babies were identified via Badgernet as having received surfactant. We included only those infants between 26 + 0 and 32 + 6 weeks gestation producing groups with comparable gestation and birth weight. Using a data collection form and retrospective analysis of the Badgernet generated database we compared the demographics and long-term outcomes for infants receiving surfactant via LISA to those following intubation. Rates of bronchopulmonary dysplasia were collected from NNAP data. <h3>Results</h3> We found that there was a reduction in median invasive ventilation days (0 vs. 2 days), non-invasive respiratory support days (0 days vs. 39 days) and total oxygen days (5 vs. 34.5 days) in the LISA cohort compared those receiving surfactant via endotracheal tube. One infant required home oxygen in the LISA cohort vs. eight in the non-LISA. There was a 9% reduction in BPD rates after introduction of LISA according to NNAP data. Eight babies required intubation following unsuccessful LISA. Compared to their successful counterparts median invasive ventilation days, non-invasive respiratory support days and total oxygen days were 1.5 days, 17.5 days and 10 days respectively. Of the babies who required intubation five had a complete course of antenatal steroids, and three an incomplete course. <h3>Conclusions</h3> Following the introduction of LISA we successfully saw a reduction in total ventilation days, total non-invasive ventilation days, total oxygen days and bronchopulmonary dysplasia rates. With LISA becoming a standard of care for infants requiring surfactant and part of a package aimed at reducing BPD rates in our unit, we hope to see a sustained reduction in ventilation days and BPD rates. As no discriminating factor amongst those infants requiring intubation post LISA could be identified no changes have been made to the eligibility criteria for LISA.