Minimally Invasive Surfactant Therapy Research Articles

Comparing the Effects of Two Surfactant Administration Methods: Minimally Invasive Surfactant Therapy (MIST) with Intubation (INSURE) in Infants with Respiratory Distress Syndrome.

The aim of this study is to investigate and compare the effects of administering a surfactant through a fine intra-tracheal catheter during spontaneous breathing with the usual INSURE method in premature infants. In this clinical trial, premature babies with respiratory distress syndrome who required surfactant administration were randomly assigned to two groups: an intervention group (MIST) and a control group (INSURE). The treatment results were compared in terms of complications related to treatment (desaturation, apnea, bradycardia, and surfactant reflux), respiratory complications (requirement for mechanical ventilation, duration of nCPAP, duration of oxygen requirement, frequency of pneumothorax, and pulmonary hemorrhage), complications related to prematurity (incidence of IVH, NEC, BPD, and PDA), the need for a second dose of surfactant, and the duration of hospitalization. a total of 160 premature babies with a gestational age of 26-34 weeks were randomly divided into two groups. The results showed that the need for mechanical ventilation, the duration of CPAP needed, and the duration of oxygen therapy were significantly lower in the MIST group than in the INSURE group. Additionally, the incidence of BPD was less common in the MIST group compared to the INSURE group. However, surfactant reflux was more common in the MIST group than in the INSURE group. There were no significant differences between the two groups in other outcomes, including the length of hospital stay and complications such as IVH, PDA, NEC, pneumothorax, and pulmonary hemorrhage. The results of this research demonstrate that the less invasive method of surfactant therapy (MIST) is a feasible, effective, and low-risk alternative to the INSURE method.

Influence of catheter thickness on respiratory physiology during less invasive surfactant administration in extremely preterm infants.

Delivering surfactant via thin catheters (minimal-invasive surfactant therapy (MIST); less invasive surfactant administration (LISA)) has become a common procedure. However, the effect of tracheal obstruction caused by catheters of different sizes on tracheal resistance in extremely low gestational age newborns (ELGANs) is unknown. To investigate the effect of catheters size 3.5, 5 and 6 French on airway resistance in ELGANs of 23-28 weeks gestational age during LISA, we performed calculations based on Hagen-Poiseuille's law and compared these with a clinically and physically more accurate method: computational fluid dynamics (CFD) simulations of respiratory airflow, performed in 3D virtual airway models derived from MRI. The presence of the above catheters decreased the cross-sectional area of the infants' tracheal entrance (the cricoid ring) by 13-53%. Hagen-Poiseuille's law predicted an increase in resistance by 1.5-4.5 times and 1.3-2.6 times in ELGANs born at 23 and 28 weeks, respectively. However, CFD simulations demonstrated an even higher increase in resistance of 3.4-85.1 and 1.1-3.5 times, respectively. The higher calculated resistances were due to the extremely narrow remaining lumen at the glottis and cricoid with the catheter inserted, resulting in a stronger glottal jet and turbulent airflow, which was not predicted by Hagen-Poiseuille. Catheter thickness can greatly increase tracheal resistance during LISA-procedures in ELGANs. Based on these models, it is recommended to use the thinnest catheter possible during LISA in ELGANs to avoid unnecessary increases in airway resistance in infants already experiencing dyspnea due to respiratory distress syndrome.

The Outcomes of Preterm Infants with Neonatal Respiratory Distress Syndrome Treated by Minimally Invasive Surfactant Therapy and Non-Invasive Ventilation.

In recent years, the utilization of minimally invasive surfactant therapy (MIST) and Non-invasive ventilation (NIV) as the primary respiratory assistance has become increasingly prevalent among preterm infants with neonatal respiratory distress syndrome (RDS). This study aims to compare the outcomes between MIST administered with nasal continuous positive airway pressure (NCPAP) versus nasal intermittent positive pressure ventilation (NIPPV), with the objective of exploring the respiratory therapeutic benefits of these two approaches. This retrospective study collected data from the neonatal intensive care unit of Kaohsiung Medical University Hospital spanning from January 2016 to June 2021. Infants were divided into two groups based on the type of NIV utilized. The NCPAP group comprised 32 infants, while the NIPPV group comprised 22 infants. Statistical analysis revealed significant differences: the NIPPV group had a smaller gestational age, lower birth weight, higher proportion of female infants, and earlier initiation of MIST. Additionally, the NIPPV group exhibited higher incidence rates of retinopathy of prematurity, longer respiratory support duration, prolonged hospitalization, and mortality. However, upon adjustment, these differences were not statistically significant. Analysis of venous blood gas and respiratory parameter changes indicated that both the NCPAP and NIPPV groups experienced improvements in oxygenation and ventilation following MIST.

MIST or INSURE in Preterm Infants with Respiratory Distress Syndrome

AbstractPremature infants with respiratory distress syndrome (RDS) are typically administered surfactant via the intubation and extubation procedure (INSURE). A variety of surfactant administration practices are available today. The term “SURE” (surfactant without endotracheal intubation) refers to any approach that requires direct laryngoscopy but uses a narrow catheter instead of an endotracheal tube. They include Take Care, LISA (least invasive surfactant administration), and MIST (minimally invasive surfactant therapy). MIST approaches avoid intubation while minimizing airway damage and barotrauma. This study sought to determine the practicality, effectiveness, and security of using the MIST approach to administer surfactant to premature infants with RDS. The study examined 90 preterm infants who were born before 36 weeks with respiratory distress and were able to breathe on their own. They were divided into two groups of 45 infants each: the MIST and INSURE groups. Both surfactant administration procedures were tested to determine their impact on morbidity and mortality in newborns. The study revealed no noticeable differences between both groups in maternal or newborn factors. Still, the MIST group exhibited a significantly decreasing necessity of mechanical ventilation (MV), had shorter MV and continuous positive airway pressure durations, and significantly reduced periventricular–intraventricular hemorrhage (PIVH) and death. The MIST procedure is pragmatic and reliable, and it decreases the need for MV and mortality in preterm infants who need surfactant treatment. It decreases the occurrence of PIVH in susceptible subgroups.

Early Cpap and Large Volume Minimal Invasive Surfactant Administration (Ecalmist)

Large volume surfactant administration in premature infants less than 35 weeks using minimally invasive surfactant therapy (MIST). Background: Surfactant in small volume preparations can be successfully administered to premature infants using a narrow-bore vascular catheter inserted into the trachea under direct vision. It was not known if surfactant in large volume preparations could be administered effectively to spontaneously breathing premature infants while maintaining them on nasal continuous positive airway pressure (nCPAP). Objective: To evaluate the feasibility of administering a large volume of surfactant (5 ml/kg) in spontaneously breathing premature infants on nCPAP using a vascular catheter. Methods: Single-arm interventional trial in two level III nurseries in Canada. Spontaneously breathing premature infants between 24- and 34-weeks’ gestation, born between July 4th, 2012 and September 5th, 2012 were eligible for the trial in the first 24 hours of life. A 16-gauge vascular catheter was inserted under direct vision through the vocal cords to administer 5 ml/kg of surfactant while maintaining the infants on nCPAP. Results: Twenty-one premature infants were enrolled. The mean gestational age was 29 ± 3 (range 24 to 34 weeks) with mean birth weight of 1474 ± 575 g. Surfactant was successfully administered in 20 infants (95 %). There was a clear effect after surfactant administration with a decrease in oxygen requirement from 0.34 ± 0.111 before the procedure, to 0.26 ± 0.08 after the procedure (p = .001), and a decrease in nCPAP pressure from 7.2 ± 0.5 cm H2O before the procedure to 5.9 ± 0.5 after the procedure (p < .0001). The mean duration for surfactant administration was 8.3 ± 3.4 minutes. The procedure was temporarily stopped in three cases due to bradycardia and/or apnea with desaturations that spontaneously recovered without intervention. Coughing and reflux of the surfactant were transiently observed in four cases (19 %). Conclusion: It is feasible to administer large volumes of surfactant without interrupting nCPAP via a vascular catheter, to premature infants less than 35 weeks’ gestation. Further trials are needed to confirm the safety and efficacy of this method compared to other methods of surfactant administration.

Purpose Built Catheters for Minimally Invasive Surfactant Therapy: Experience from a Canadian Tertiary Level Neonatal Intensive Care Unit.

Minimally invasive surfactant therapy (MIST), a method of surfactant delivery via a thin catheter during spontaneous breathing, is an increasingly popular alternative to intubation and surfactant administration. Recently, purpose-built catheters for MIST received regulatory approval in Canada and became available for use. However, procedural success and user experience with such catheters have not been described. This retrospective cohort study included neonates who received MIST using purpose-built catheters between January 1, 2021, and March 31, 2022. Two types of purpose-built catheters were used in this period - SurfCath™ and BLEScath™. Procedural success, number of attempts, and adverse events in neonates receiving MIST via the two catheters were compared using chi-square or Fisher's tests. User experience was described using an ease-of-use scale. Thirty-seven neonates met eligibility criteria; 22 received MIST via SurfCath™, whereas 15 received MIST via BLEScath™. Success rates were 91% in SurfCath™ and 93% in BLEScath™ (P> 0.994). Failed attempts were lower in SurfCath™ (23%) in comparison to BLEScath™ (33%), but the difference was not statistically significant (P=0.708). Among operators, 90% found SurfCath™ very easy/relatively easy to use compared to 43% of users reflecting the same degree of use with BLEScath™ (P=.021). There was no difference in adverse events. This is the first study in Canada to report MIST with purpose-built catheters. Overall, the success rate was equally high with both catheters. Users subjectively reported higher ease of use with SurfCath™. Commercially available purpose-built catheters should facilitate universal adaptation of the MIST method.

EE56 Minimally Invasive Surfactant Treatment Versus Standard Therapy in Preterm Infants at Birth (OPTIMIST-A TRIAL): An Analysis of Initial Hospitalisation Costs and Resource Consumption

To compare the per capita costs of initial hospitalisation in infants receiving minimally invasive surfactant therapy (MIST) or standard treatment (ST) using data from a multicentre blinded parallel group RCT (OPTIMIST-A trial, JAMA 2021, 326:2478).

Pain and Physiological Stress During Minimally Invasive Surfactant Therapy (MIST) in Very Preterm Infants

Pain and Physiological Stress During Minimally Invasive Surfactant Therapy (MIST) in Very Preterm Infants

A Study to assess the effectiveness of Video Assisted Teaching Program on knowledge regarding minimally invasive surfactant therapy among nursing students in selected nursing colleges, Satna

Background: Minimally invasive surfactant therapy (MIST) is a new mode of surfactant administration without intubation to spontaneously breathing preterm infants with respiratory distress syndrome (RDS).1 Use of this therapy is growing in Neonatal Units, as it reduces the intubation rate and the pathology associated with intubation and allows surfactant to be administered to patients in need2 Objective: The present study aimed to assess the effectiveness of video assisted teaching program on knowledge regarding minimally invasive surfactant therapy among nursing students in selected nursing colleges, Satna. Methodology: Pre-experimental, one group pre-test post-test design was adopted for this study. 40 student Nurses studying in selected colleges, Satna were selected by using simple random sampling method for this study. A pre test was conducted by using structured knowledge questionnaire and on the same day the video assisted teaching program regarding minimally invasive surfactant therapy was administered to them. After 7 days, post test was conducted with the same questionnaire for the same group of student nurses to assess the effectiveness of video assisted teaching program. Result: The mean score in the post test is 25.2 and the mean score in the pre test is 8.2. The calculated value of t is 31.8 which is highly significant. The result confirms that the video assisted teaching program was effective significantly in improving the knowledge on minimally invasive surfactant therapy among the student nurses.

МИНИМАЛЬНО ИНВАЗИВНОЕ ВВЕДЕНИЕ БЕРАКТАНТА У НЕДОНОШЕННЫХ МЛАДЕНЦЕВ С ГЕСТАЦИОННЫМ ВОЗРАСТОМ МЕНЕЕ 32 НЕДЕЛЬ: РЕЗУЛЬТАТЫ РЕТРОСПЕКТИВНОГО КОГОРТНОГО ИССЛЕДОВАНИЯ

The aim of the study was to analyze respiratory therapy and the outcomes of nursing preterm infants with gestational age (GA) of less than 32 weeks, who received Beractant in various ways in order to determine the most optimal methods of surfactant administration. Materials and methods of research: a multicenter retrospective cohort study. It was carried out in nine perinatal centers in different regions of the Russian Federation in the period from 07/01/2019 to 06/30/2020. A total of 258 preterm infants with GA of less than 32 weeks participated in the study. One surfactant was used – Beractant (Survant®) at a dose of 100 mg/kg for the first and repeated administration. Beractant was injected by LISA, INSURE or through an endotracheal tube (ETT). Two groups – 1st (154 children) – administration of Beractant via ETT, 2nd (104 children) – minimally invasive surfactant therapy (MIST) of Beractant – combined the LISA and INSURE methods. Two subgroups were identified in the 2nd group: subgroup 2a (27 children) – administration of Beractant by the LISA method, subgroup 2b (77 children) – administration of Beractant by the INSURE method. Results: the ETT and MIST groups were comparable in terms of the median GA (30 versus 30 weeks, p=0.107, respectively) and body weight at birth (1244 versus 1405 g, p=0.067, respectively). In the ETT group in comparison with the MIST group, the administration of Beractant was performed earlier (10 versus 15 min of life, p=0.003, respectively), the need for respiratory support was longer (196.0 versus 120.0 h, p=0.001, respectively), the need for high-frequency oscillatory ventilation was more common (19.7% versus 7.7%, p<0.001, respectively), as well as the need for invasive mechanical ventilation by 72 hours of life (95.4% versus 31.7%, p<0.001, respectively). The incidence of bronchopulmonary dysplasia (BPD) and the length of stay in the intensive care unit and neonatal intensive care unit (NICU) in the ETT group significantly outperformed the MIST group (35.8% versus 13.6%, p<0.001; 10.0 versus 6,0 days, p<0.001, respectively). There were no differences in the frequency of deaths, intraventricular hemorrhages, pneumothoraxes and other complications. The INSURE and LISA subgroups differed in GA and birth weight (30.0 versus 28.0 weeks, p=0.048; 1490.0 versus 1100.0 g, p=0.001, respectively). Conclusions: minimally invasive administration of Beractant significantly reduces the need for invasive respiratory therapy, and, as a result, the incidence of BPD in premature infants with GA of less than 32 weeks.

Minimally or less invasive surfactant replacement therapy in neonates: A narrative review

Surfactant replacement therapy is a major cornerstone in the successful management of neonates with respiratory distress syndrome. Until recently, the INtubate, SURfactant, Extubate protocol was the best a trade-off achieved to deliver the surfactant to the air exchanging respiratory epithelium against the barotrauma of prolonged intubation and ventilation. Minimal or Less Invasive Surfactant Therapy (MIST or LISA) was adapted in clinical practice as a gentler and a gentler way of delivering surfactant. LISA or MIST is associated with a significant reduction in the oxygen days and chronic lung disease, intraventricular hemorrhage of grade 2 or above, retinopathy of prematurity and other key neonatal outcomes. This translates into shortened neonatal intensive care unit stay and a significant reduction in the stress levels of neonatal nurses, parents, and caregivers. This procedure needs to be performed by skilled professionals with appropriate training to achieve the desired results.

A study on the comparison of minimally invasive surfactant therapy with insure technique of surfactant therapy in preterm babies with respiratory distress in a tertiary care hospital – A prospective cohort study

Background: Respiratory distress syndrome (RDS) is a common problem in preterm babies due to surfactant deficiency. Initially, babies were given surfactant therapy by intubation, surfactant administration, and extubation (INSURE) method. Minimally invasive surfactant therapy (MIST) is a novel method of surfactant administration without intubation to spontaneously breathing preterm babies with RDS without the removal of continuous positive airway pressure (CPAP). Aim: This study aims to compare the surfactant therapy in preterm babies with RDS through MIST and INSURE technique. Methods: This prospective, observational cohort study was conducted in the neonatology unit of Calcutta National Medical College and Hospital. A total of 212 preterm babies of <37 weeks of gestation with features of RDS, who require surfactant are taken and divided into two groups. Very sick babies with congenital anomalies are excluded from the study. In MIST group (n=102), 8 Fr feeding tube is used to deliver surfactant while the baby is on CPAP. In INSURE group (n=102), surfactant is given by intubation through endotracheal tube without CPAP and extubated. Results: Mean birth weight was 1.26 kg in MIST and 1.22 kg in INSURE. Mean gestational age was 31.33 weeks in MIST and 31.11 weeks in INSURE. It was observed that there is a significant difference in terms of duration of oxygen requirement, neonatal intensive care unit stay, and surfactant spillage during administration in MIST group compared to INSURE group. However, duration of mechanical ventilation, CPAP, number of doses of surfactant, sepsis, intraventricular hemorrhage, retinopathy of prematurity, pneumothorax, bronchopulmonary dysplasia, and mortality did not show significant difference in both the groups. Conclusion: MIST is safe, feasible, and more beneficial than INSURE technique.

Airway injury and pneumomediastinum associated with less invasive surfactant administration in a premature neonate: a case report

BackgroundThe use of less invasive surfactant administration (LISA)/minimally invasive surfactant therapy (MIST) has increased due to its potential advantage over traditional surfactant delivery methods through an endotracheal tube. Known complications for this procedure include failure of the first attempt at insertion, desaturation, and bradycardia. To the best of our knowledge, this is the first reported case of pneumomediastinum and subcutaneous emphysema following LISA.Case presentationA preterm newborn born at 27 weeks of gestation presented with respiratory distress syndrome requiring surfactant replacement. LISA using the Hobart method was completed. There was a report of procedural difficulty related to increased resistance to insertion of the 16G angiocath. The newborn was subsequently noted to have subcutaneous emphysema over the anterior aspect of the neck and substantial pneumomediastinum on radiological assessment. Associated complications included hypotension requiring inotropic support. The newborn was successfully managed conservatively, with complete resolution of the air leak.ConclusionsUpper airway injury leading to air leak syndrome is a rare complication of the Hobart method for LISA. Awareness of such procedural complications is important as the use of the LISA method increases.

13 Impact of Catheter Choice on Procedural Success of Minimally Invasive Surfactant Therapy

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Surfactant delivery via a thin endotracheal catheter during spontaneous breathing, a technique called minimally invasive surfactant therapy (MIST), is an alternative to intubation and surfactant administration. Procedural details among different centres vary, with marked differences in the choice of catheter to instill surfactant. Studies report use of feeding catheters, multi-access catheters, vascular catheters and, recently, custom-designed catheters for this purpose. The impact of choice of catheter on procedural success and adverse effects has not been reported. Objectives The objective of the present study was to compare the procedural success and adverse effects of MIST, using a semi-rigid vascular catheter (16G Angiocath-Hobart Method) versus a flexible multi-access catheter (MAC). Design/Methods This was a retrospective review of prospectively collected data at a tertiary care neonatal intensive care unit in southwestern Ontario. All neonates who received surfactant via MIST between May 1, 2016 and September 30, 2020 were included in the study. Relevant baseline characteristics, data on procedural details (premedication, type of catheter) were collected. The procedural success, number of attempts, and adverse effects between neonates who received MIST via MAC and 16G Angiocath were compared using a Chi Square test or Fisher’s test, as appropriate. A P value of less than 0.05 was considered significant. Results A total of 139 neonates received surfactant via MIST method during the study period. 93 neonates received the surfactant via MAC, while 46 received it via Angiocath. The baseline demographic characteristics in the two groups were similar (Table 1). A higher proportion of neonates in the Angiocath group received atropine (100% vs. 76%, P =.002] and fentanyl (98% vs. 36%; p<0.001) than the MAC group. The procedural success was 91% in the Angiocath group and 89% in the MAC group (p >.99). Multiple attempts were needed in 24% of neonates in the Angiocath group, and 37% in the MAC group (p=0.158). More episodes of desaturations were noted in the Angiocath group (89%) than the MAC group (69%) (P=0.012). Other rates of common adverse effects were similar between the two groups (Table 2). Conclusion The overall procedural success of MIST was similar in both catheter groups. The proportion of neonates requiring multiple attempts was lower with Angiocath use, though this difference was not statistically significant. Desaturation episodes were seen more frequently in the Angiocath group, possibly related to higher use of procedural sedation in this group.

Impact of Catheter Choice on Procedural Success of Minimally Invasive Surfactant Therapy.

Surfactant delivery via a thin endotracheal catheter during spontaneous breathing; a technique called minimally invasive surfactant therapy (MIST) is an alternative to intubation and surfactant administration. Procedural details among different centers vary, with marked differences in the choice of catheter to instill surfactant. Studies report use of feeding catheters, multiaccess suction catheters, vascular catheters, and more recently custom-built catheters for this purpose. The impact of choice of catheter on procedural success and procedural adverse effects has not been reported. Our present study compares the procedural success and adverse effects of MIST using a semirigid vascular catheter (16G Angiocath-Hobart Method) versus a flexible multiaccess catheter (MAC). This was a retrospective review of prospectively collected data at a tertiary care neonatal intensive care unit in Southwestern Ontario. All neonates who received surfactant via MIST between May 1, 2016 and September 30, 2020 were included in the study. Relevant baseline characteristics and data on procedural details (premedication, type of catheter, etc.) were collected. The procedural success, number of attempts, and adverse effects between neonates who received MIST via MAC and 16G Angiocath was compared by using Chi-square test or Fisher's test as appropriate. A p-value of less that 0.05 was considered significant. A total of 139 neonates received surfactant via MIST method during the study period. Moreover, 93 neonates received the surfactant via MAC, while 46 received it via Angiocath. The baseline demographic characteristics in the two group were similar. A higher proportion of neonates in Angiocath group received Atropine (100 vs. 76%, p = 0.002) and Fentanyl (98 vs. 36%, p < 0.001) than the MAC group.The procedural success was 91% in the Angiocath group and 89% in the MAC group (p > 0.99). Multiple attempts were needed in 24% of neonates in the Angiocath group and 37% in the MAC group (p = 0.158). More episodes of desaturations were noted in the Angiocath group (89%) than the MAC group (69%; p = 0.012). Other rates of common adverse effects were similar between the two groups. On exploratory analysis fentanyl use held significant association with less success, more desaturation, apneic episodes, and need of positive pressure ventilation /intubation. The overall procedural success of MIST is similar in both catheter groups. The proportion of neonates requiring multiple attempts was lower with the Angiocath, though difference was not statistically significant. Desaturation episodes were seen more frequently in the Angiocath group, which was related to higher use of procedural sedation in this group. · MIST is emerging as a less invasive method of surfactant delivery that has proven clinical benefits.. · Considerable, procedural variation is reported, particularly regarding choice of catheter.. · Our present study compares the procedural success and adverse effects of MIST using a semirigid vascular catheter (16G Angiocath-Hobart method) versus a flexible MAC.. · High and comparable procedural success was seen in both groups..

Introduction of a Quality Improvement Bundle Is Associated with Reduced Exposure to Mechanical Ventilation in Very Preterm Infants

Introduction: Exposure to mechanical ventilation (MV) is a risk factor for bronchopulmonary dysplasia (BPD) in very preterm infants (VPTIs). We assessed the impact of a quality improvement (QI) bundle in VPTIs (<32 week gestation) on exposure to MV. Methods: We introduced a QI bundle consisting of deferred cord clamping (DCC), nasal bubble continuous positive airway pressure (bCPAP) in the delivery room (DR), and minimally invasive surfactant therapy (MIST). We compared respiratory outcomes and neonatal morbidity in historical pre-QI (July–December 2017) and prospective post-QI (February–July 2019) cohorts (QICs) of VPTIs. We pre-specified an adjusted analysis to account for the effects of gestational age, sex, antenatal steroids, and any demographic data that significantly differed between cohorts. Results: The pre-QI and post-QICs included 87 and 98 VPTIs, respectively. The post-QIC had decreased rates of MV in the DR (adjusted odds ratio [aOR] 0.26, 95% confidence interval [CI] 0.09–0.71), in the first 72 h of life (aOR 0.27, 95% CI 0.11–0.62) and during admission (aOR 0.28, 95% CI 0.12–0.66). Rates of BPD, combined BPD/death, and BPD severity were similar. The post-QIC was less likely to be discharged with home oxygen (aOR 0.27, 95% CI 0.08–0.91). Necrotising enterocolitis grade ≥2 increased (aOR 19.01, 95% CI 1.93–188.6) in the post-QIC. Conclusion: In this rapid-cycle QI study, implementation of a QI bundle consisting of DCC, early nasal bCPAP, and MIST in VPTIs was associated with reduced rates of MV in the DR, in the first 72 h of life and during admission, and reduced need for home oxygen.

Comparison of minimally invasive surfactant therapy with intubation surfactant administration and extubation for treating preterm infants with respiratory distress syndrome: a randomized clinical trial.

Background Respiratory distress syndrome (RDS) is a common cause of hospitalization and death in preterm infants who require surfactant treatment and respiratory support.Purpose This study aimed to compare the clinical outcomes of minimally invasive surfactant therapy (MIST) and the INtubation, SURfactant administration, and Extubation (INSURE) technique in preterm infants with RDS.Methods In this clinical trial, 112 preterm infants born at 28–36 weeks of gestation and diagnosed with RDS randomly received 200-mg/kg surfactant by MIST or the INSURE method. In the MIST group, surfactant was administered using a thin catheter (5F feeding tube); in the INSURE group, surfactant was administered after intubation using a feeding tube and the tracheal tube was removed after positive pressure ventilation was started. Nasal continuous positive airway pressure was applied in both groups for respiratory support and the postprocedure clinical outcomes were compared.Results The mean hospitalization time was shorter for infants in the MIST group than for those in the INSURE group (9.19± 1.72 days vs. 10.21±2.15 days, P=0.006). Patent ductus arteriosus was less frequent in the MIST group (14.3% vs. 30.4%, P=0.041). Desaturation during surfactant administration occurred less commonly in the MIST group (19.6% vs. 39.3%, P=0.023). There were no significant intergroup differences in other early or late complications.Conclusion These results suggest that surfactant administration using MIST could be a good replacement for INSURE in preterm infants with RDS since its use reduced the hospitalization time and the number of side effects.

Minimally invasive surfactant therapy versus intubation for surfactant delivery in preterm infant with RDS: evaluation of safety and efficacy

Background Minimally invasive surfactant therapy (MIST) is a promising mode of administration that offers the potential to limit barotrauma and prevent lung injury in preterm infants with respiratory distress syndrome (RDS). Objective This study assessed the effects of the implementation of MIST on safety and efficacy in infants who met criteria for surfactant administration and were treated by MIST as compared with a historical control group treated with surfactant via an endotracheal tube during mechanical ventilation. Methods This retrospective study included infants born between 2012 and 2017 who met the following inclusion criteria: gestational age 23–36 + 6 weeks, a diagnosis of RDS requiring at least 30% oxygen with or without nasal continuous positive airway pressure (nCPAP). MIST was introduced in 2014 and a comparison was made between the study group who received MIST and the control group who met similar criteria and received surfactant via an endotracheal tube during mechanical ventilation Results No significant differences were found between the groups in baseline and demographic data. Severity of initial disease, assessed by the CRIB II score, was similar in the two groups (control 4.6 ± 2.8, MIST 4.4 ± 2.4, p=.995). The requirement for oxygen during the first 3 d of life was significantly lower (area under the curve [AUC]: p=.001) in the MIST group as assessed by the AUC. Likewise, the mean days of oxygen requirement were significantly lower in the MIST group (Control: 10.3 d, MIST: 5.9 d, p=.04). Only six infants in the MIST group (13%) subsequently required intubation for mechanical ventilation, only one of whom adjacent to the procedure. A modest reduction in duration of ventilation was also noted. Duration of admission was 32 ± 23 d in the control group and 26 ± 21 d in the MIST group, p=.061. No significant differences were found between the groups in the incidence of major morbidities or mortality. No major adverse events related to the procedure were observed. Conclusions Transition to MIST was associated with significantly reduced need for oxygen, mechanical ventilation and surfactant, and a borderline shortened NICU admission.

Minimally invasive surfactant therapy for moderate to late premature neonates with respiratory distress syndrome born in a non-tertiary unit.

Minimally invasive surfactant therapy (MIST) is used to deliver exogenous surfactant to preterm neonates with respiratory distress syndrome. The objective of this study was to review the use of MIST in moderate to late preterm neonates born in a non-tertiary unit. A retrospective review was conducted of neonates receiving MIST in a non-tertiary unit. MIST was considered in neonates requiring continuous positive airway pressure ≥ 6cm H2 O and fraction of inspired oxygen ≥ 0.35. The Hobart method was used to deliver exogenous surfactant. The primary outcome was improvement in respiratory function. Secondary outcomes include intubation and transfer to a tertiary unit. Between 2016 and 2020, 23 infants were treated with MIST. The median gestational age was 33+5 ± 2.7 weeks and mean age of surfactant administration was 6.6± 3.6h. Surfactant administration resulted in a reduction in median fraction of inspired oxygen from 0.3 to 0.21 at 4h post MIST (P value: 0.001), and a reduction in median positive end-expiratory pressure (PEEP) from 7 to 6 cm H2 O at 24 h post MIST (P value: 0.003). Continuous positive airway pressure support was required for a median period of 3.5 days following MIST. There was respiratory improvement in 52 and 65% of neonates at 4 and 24 h, respectively, following MIST. The incidence of intubation was 13% and transfer to a tertiary unit was 44%. Use of MIST at this unit improved respiratory outcomes in moderate to late preterm neonates with respiratory distress syndrome. This procedure was well tolerated with few adverse events. Further research evaluating the efficacy of MIST in other non-tertiary units is warranted.

Terapêutica com surfactante em recém-nascidos prematuros: tendência para uma abordagem menos invasiva

Introduction: Minimally invasive surfactant therapy (MIST) is a surfactant administration procedure that intends to reduce intubations and associated risks. The aim of this study was to compare MIST with INtubation-SURfactant-Extubation (INSURE) technique. Material and methods: Retrospective analysis (from January 2015 to June 2019) of preterm infants on nasal continuous positive airway pressure (nCPAP) treated with surfactant. Results: Fifty-four preterm infants were included and divided in two groups: MIST (n=34) and INSURE (n=20). No significant differences were found between groups regarding gestational age (p=0.480), birth weight (p=0.299), fraction of inspired oxygen (FiO2) prior to surfactant (p=0.220), oxygen therapy duration (p=0.306), progression to intubation (p=0.712), or length of Neonatal Intensive Care Unit stay (p=0.778). FiO2 variation before and after surfactant administration was higher in MIST group (14% vs 9%, p=0.078). No significant complications were reported with either technique. Conclusions: MIST is a safe technique in preterm infants on nCPAP. This study shows similar outcomes with MIST and INSURE procedures, with a greater reduction in FiO2 requirements with MIST. Overall, MIST is less invasive and as effective as INSURE in preterm infants.