Feasibility of less invasive surfactant administration (LISA) in the delivery suite

Abstract

Introduction: Nowadays, practitioners prefer to use non-invasive methods of respiratory support with avoidance of intubation. As a consequence, surfactant is often given as rescue treatment on the neonatal unit, if infants require intubation because of increasing severity of respiratory distress. Less invasive surfactant administration (LISA) is increasingly being used on the neonatal unit, as surfactant can be delivered without need of intubation. This technique then could be used to deliver surfactant earlier in the infant9s respiratory illness. Aim: To assess the feasibility of LISA in the delivery suite. Methods: Inborn infants between 26 to 35 weeks of gestation were considered eligible for LISA, using a surfactant dose of 200mg/kg. Respiratory function monitoring was undertaken before and after LISA. Results: During a nine month period there were 127 eligible infants; 44 had apnoeas/poor respiratory effort and required intubation in the delivery suite. Twenty-seven infants all of greater than 30 weeks of gestational age had no respiratory distress. Nineteen infants had respiratory distress deemed too mild in the delivery suite to require surfactant, but six subsequently had LISA on the neonatal unit. Thirty-seven infants with a median (IQR) gestational age of 31+3 weeks (30+3-33+4) weeks had LISA on the delivery suite which resulted in an improvement in oxygenation and reduction in respiratory rate. Surfactant reflux, desaturation and bradycardia occurred in 16 infants, but responded to a slowing in the speed of administration of surfactant. There were no serious adverse consequences. Conclusion: LISA is feasible in the delivery suite and can result in improvement in respiratory status.