Effects of less invasive surfactant administration versus intubation-surfactant-extubation on bronchopulmonary dysplasia in preterm infants with respiratory distress syndrome: a single-center, retrospective study from China

Abstract

Background This study evaluated the effects of less invasive surfactant administration (LISA) and intubation-surfactant-extubation (InSurE) on bronchopulmonary dysplasia (BPD) in preterm infants with respiratory distress syndrome (RDS). Methods Neonates with respiratory distress syndrome requiring surfactant, with gestational age < 32 weeks and birth weight < 1500 g admitted to our neonatal intensive care unit from January 2018 to December 2019, were retrospectively analyzed. LISA and InSurE were used independently. The incidence of BPD at 36 weeks postmenstrual age, pre-discharge mortality, and need for mechanical ventilation (MV) within 72 h of birth were compared between LISA and InSurE group. Secondary outcomes including necrotizing enterocolitis requiring surgery, retinopathy of prematurity ≥ stage 3, patent ductus arteriosus requiring medical therapy or surgery, and length of hospitalization were analyzed. Results Among the 148 included neonates, there were 46 and 102 infants in LISA group and InSurE group, respectively. There were no significant differences in BPD incidence, the severity of BPD at 36 weeks postmenstrual age, and the rate of MV within the first 72 h after birth between the two groups (P > 0.05, respectively). The incidences of necrotizing enterocolitis requiring surgery, retinopathy of prematurity ≥ stage 3, patent ductus arteriosus requiring medical therapy or surgery, and length of hospitalization did not differ significantly between the two groups (P > 0.05, respectively). Conclusions For surfactant administration among preterm infants with respiratory distress syndrome, LISA did not decrease bronchopulmonary dysplasia and severity of BPD at 36 weeks postmenstrual age. The benefits of LISA would require further evaluations.

Comparison of mortality and short-term outcomes between classic, intubation-surfactant-extubation, and less invasive surfactant administration methods of surfactant replacement therapy

“…Pareek et al also observed no statistically significant differences in major complication rates, duration of respiratory support, hospital stay, and mortality between LISA and InSurE groups ( 28 ). Likewise, Xu et al found no significant differences in the incidence of BPD, severity of BPD at 36 weeks postmenstrual age, and the rate of mechanical ventilation within 72 h after birth when comparing the LISA and InSurE groups ( 29 ). Therefore, the superiority of LISA over InSurE remains controversial.…”

“…We suspect that this difference in familiarity may have influenced the observed results. However, numerous studies have compared LISA and InSurE for preterm infants, and the findings suggest that there are no significant differences between these two approaches ( 26 – 29 ). Gupta et al found no disparities in the need for invasive mechanical ventilation in the first 72 h of life, hemodynamically significant PDA, IVH (>grade 2), BPD, and combined outcome of BPD/mortality when comparing MIST, which is used interchangeably with LISA, and InSurE ( 26 ).…”

“…We suspect that this difference in familiarity may have influenced the observed results. However, numerous studies have compared LISA and InSurE for preterm infants, and the findings suggest that there are no significant differences between these two approaches (26)(27)(28)(29). Gupta (29).…”

“…However, numerous studies have compared LISA and InSurE for preterm infants, and the findings suggest that there are no significant differences between these two approaches (26)(27)(28)(29). Gupta (29). Therefore, the superiority of LISA over InSurE remains controversial.…”