Less invasive surfactant administration and complications of preterm birth

Abstract

In a large cohort study of the German Neonatal Network (GNN) we aimed to evaluate whether less invasive surfactant administration (LISA) strategy is associated with complications of preterm birth. Within the observational period n = 7533 very-low-birth-weight infants (VLBWI) with gestational age 22 0/7 to 28 6/7 weeks were enrolled in GNN; n = 1214 VLBWI never received surfactant, n = 2624 VLBWI were treated according to LISA procedure, n = 3695 VLBWI had surfactant via endotracheal tube (ETT). LISA was associated with a reduced risk for adverse outcome measures including mortality [odds ratio (OR) 0.66 (95% CI: 0.51–0.84), p < 0.001] bronchopulmonary dysplasia [BPD; OR 0.55 (95% CI: 0.49–0.62), p < 0.001], intracerebral hemorrhage (ICH) grade II-IV [OR 0.55 (95% CI: 0.48–0.64), p < 0.001] and retinopathy of prematurity [ROP; OR 0.62 (95% CI: 0.45–0.85), p < 0.001]. Notably, LISA was associated with an increased risk for focal intestinal perforation [FIP; OR 1.49 (95% CI: 1.14–1.95), p = 0.002]. The differences in FIP rates were primarily observed in VLBWI born <26 weeks (LISA: 10.0 vs. ETT: 7.4%, p = 0.029). Our observational data confirm that LISA is associated with improved outcome. In infants <26 weeks we noted an increased risk for FIP. Future randomized controlled trials including LISA need to integrate safety analyses for this particular subgroup.

Survey of less Invasive Surfactant Administration in England, slow adoption and variable practice

“…In Europe, there is already a good uptake of LISA: it is being used in 48% of European units according to a European Survey in 2017 12 and widely used within the German Neonatal Network since 2009. 13 We aimed to evaluate the use of LISA in England and determine the practices of premedication administration. Furthermore, we aimed to examine the criteria used for indication of the procedure in terms of oxygen requirement, the feasibility according to GA and location of where LISA is performed.…”

Lung deposition of nebulized surfactant in newborn piglets: Nasal CPAP vs Nasal IPPV

“…The InSurE (Intubate, Surfactant, Extubate) technique reduced the incidence of BPD and decreased the need for prolonged MV, but still requires intubation and does not fully avoid MV. The other technique(s) is LISA/MIST, less or minimal invasive surfactant administration, involving the passage of a thin catheter through the vocal cords either with or without the aid of a Magill forceps . Although LISA/MIST decreased the need for MV and reduced the incidence of BPD, it does not rule out desaturation and hemodynamic instability …”

“…The other technique(s) is LISA/MIST, less or minimal invasive surfactant administration, involving the passage of a thin catheter through the vocal cords either with or without the aid of a Magill forceps. [13][14][15] Although LISA/MIST decreased the need for MV and reduced the incidence of BPD, 15 it does not rule out desaturation and hemodynamic instability. 16 A third promising noninvasive technique with renewed interest is surfactant nebulization, which has the potential to avoid any airway instrumentation, and theoretically can be used along with all NIV techniques.…”

A novel delivery system for supraglottic atomization allows increased lung deposition rates of pulmonary surfactant in newborn piglets

“…Fifteen German centers showed decreased mortality and lower incidence of BPD when administering surfactant via a thin, flexible catheter inserted below the vocal cords in spontaneously breathing neonates while on nCPAP. [11][12][13] However, the technique requires the use of a laryngoscope and often of a Magill forceps to properly place the catheter in the trachea.…”