Abstract
BackgroundIn preterm infants with Respiratory Distress Syndrome (RDS), Less Invasive Surfactant Administration (LISA) has been established to reduce the need of mechanical ventilation and might improve survival rates without bronchopulmonary dysplasia. The aim of this study was to investigate whether NICU care has changed after introduction of less invasive surfactant administration (LISA), with regard to diagnostic and therapeutic procedures in the first week of life.MethodsInfants with gestational age < 32 weeks who received surfactant by LISA (June 2014 – December 2017, n = 169) were retrospectively compared to infants who received surfactant after intubation (January 2012 – May 2014, n = 155). Local protocols on indication for surfactant, early onset sepsis, blood transfusions and enteral feeding did not change between both study periods. Besides, as secondary outcome complications of prematurity were compared. Data was collected from electronic patient files and compared by univariate analysis through Students T-test, Mann Whitney-U test, Pearson Chi-Square test or Linear by Linear Association.ResultsAll baseline characteristics of both groups were comparable. Compared to controls, LISA patients received a higher total surfactant dose (208 vs.160 mg/kg; p < 0.001), required redosing more frequently (32.5% vs. 21.3%; p = 0.023), but needed less mechanical ventilation (35.5% vs. 76.8%; p < 0.001). After LISA, infants underwent fewer X-rays (1.0 vs. 3.0, p < 0.001), blood gas examinations (3.0 vs. 5.0, p < 0.001), less inotropic drugs (9.5% vs. 18.1%; p = 0.024), blood transfusions (24.9% vs. 41.9%, p = 0.003) and had shorter duration of antibiotic therapy for suspected early onset sepsis (3.0 vs. 5.0 days, p < 0.001). Moreover, enteral feeding was advanced faster (120 vs. 100 mL/kg/d, p = 0.048) at day seven. There were no differences in complications of prematurity.ConclusionThe introduction of LISA is associated with significantly fewer diagnostic and therapeutic procedures in the first week of life, which emphasizes the beneficial effects of LISA.
Highlights
In preterm infants with Respiratory Distress Syndrome (RDS), Less Invasive Surfactant Administration (LISA) has been established to reduce the need of mechanical ventilation and might improve survival rates without bronchopulmonary dysplasia
We found several changes in Neonatal intensive care unit (NICU) practices in early life, which may have beneficial effects on shortterm and long-term outcomes of preterm infants with RDS treated with less invasive surfactant administration (LISA) and lower use of healthcare resources
In conclusion, our findings demonstrate that introduction of LISA, as one of the minimally invasive surfactant procedures, has contributed to a change in practice towards fewer diagnostic and therapeutic interventions in preterm infants with RDS
Summary
In preterm infants with Respiratory Distress Syndrome (RDS), Less Invasive Surfactant Administration (LISA) has been established to reduce the need of mechanical ventilation and might improve survival rates without bronchopulmonary dysplasia. A significant proportion of preterm infants with respiratory distress syndrome (RDS) fails non-invasive respiratory support alone and need exogenous surfactant (SF) replacement therapy [1]. The most applied method of those is the INtubate-SURfactant-Extubate (INSURE) technique With this technique a large proportion of infants still failed to be weaned of the ventilator immediately after surfactant treatment [2]. Recent studies show that LISA might be associated with higher survival rates without bronchopulmonary dysplasia (BPD) and might lead to fewer other complications of preterm birth, such as severe IVH, when compared to endotracheal SF administration after intubation [6,7,8,9]
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