A comparative study on LISA and INSURE techniques in preterm neonates with respiratory distress syndrome

Abstract

Objective To compare the efficacy of less invasive surfactant administration (LISA) and intubation-surfactant-extubation to CPAP (INSURE) techniques in premature infants with respiratory distress syndrome (RDS). Method From January 2016 to January 2017, premature infants with RDS admitted to our hospital were prospectively and randomly assigned into the LISA group and the INSURE group. A 6F suction tube was used to drip pulmonary surfactant (PS) into the trachea with non-invasive respiratory support in the LISA group. INSURE technique and endotracheal intubation with surfactant administration were used in the INSURE group. The following indicators were examined: the time needed for intubation, the change of percutaneous oxygen partial pressure and the incidence of bradycardia during administration, regurgitation after administration, oxygen therapy duration, mechanical ventilation duration, re-administration of PS and apnea. Secondary indicators included the incidences of pneumothorax, pulmonary hemorrhage, neonatal necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), preterm retinopathy (ROP), and periventricular leukomalacia (PVL). Result A total of 145 cases were included including 76 in LISA group and 69 in INSURE group. The gestational age was 27~34 weeks. The birth weight was (1 650±480) g. No statistically significant differences existed between the two groups on the time needed for intubation, the change of percutaneous oxygen partial pressure, mechanical ventilation duration, oxygen therapy duration, the incidence of bradycardia, re-administration of PS, apnea and other complications (P>0.05). Statistically significant differences existed in the incidence of regurgitation (46.1% in LISA group vs.29.0% in INSURE group), mechanical ventilation within 72 hours (13.2% in LISA group vs.27.5% in INSURE group) and the incidence of BPD (6.6% in LISA group vs. 17.4% in INSURE group) (P<0.05). Conclusion Compared with INSURE, LISA technique is effective for the treatment of RDS and reduce invasive ventilation duration and the occurrence of BPD. Key words: Respiratory distress syndrome, newborn; Pulmonary surfactants; Less invasive surfactant administration technology; Intubation-surfactant-extubation technology; Infant, premature