Less Invasive Surfactant Administration (LISA) vs. Intubation Surfactant Extubation (InSurE) in Preterm Infants with Respiratory Distress Syndrome: A Pilot Randomized Controlled Trial

Abstract

Objective There has been an endeavor in recent years, to administer surfactant by minimally invasive techniques to neonates with surfactant deficiency. The objective of this study was to compare the need for intubation and mechanical ventilation after surfactant delivery, using Less Invasive Surfactant Administration (LISA) technique and Intubation SURfactant Extubation (InSurE), in preterm infants with respiratory distress syndrome (RDS). Methods We conducted a pilot randomized control trial (RCT) at a tertiary care center over a period of 18 months. Preterm neonates with RDS (gestational age 28–36 weeks) were randomized to receive surfactant within 6 h of birth by InSurE or LISA. The primary outcome was need for intubation and mechanical ventilation within 72 h of birth. Infants were followed until discharge for adverse events and complications. Results A total of 40 infants were analyzed (20 in each group). There was no difference in the need for intubation and mechanical ventilation within 72 h of birth between the two groups [InSurE, 6 (30%) and LISA, 6 (30%), relative risk 1.0, 95% confidence interval 0.51–1.97]. About 15% of infants in both groups had adverse events during the procedure. There was no statistically significant difference in the rates of major complications or duration of respiratory support, hospital stay and mortality. Conclusion We found LISA to be feasible and equally effective as InSurE for surfactant administration in the treatment of RDS in preterm infants. Future larger RCTs are required to compare the efficacy and long-term outcomes of LISA with the standard invasive methods of surfactant administration.

Surfactant administration in preterm babies (28–36 weeks) with respiratory distress syndrome: LISA versus InSurE, an open‐label randomized controlled trial

“…As with our study, several other trials 25–32 found no significant difference between the InSurE and LISA groups about the need for intubation within 72 h of birth. Mohammadizadeh et al 26 conducted a multicentre RCT in Iran among 38 preterm babies below 34 weeks gestational age and found insignificant difference in the need for intubation within first 72 h of life.…”

Sedation for less invasive surfactant administration in preterm infants: a systematic review and meta-analysis

“…One RCT 29 and two observational studies 30,31 with an intervention and comparator arm were analyzed in a pairwise meta-analysis. Nineteen single arms of RCTs 5,6,[32][33][34]37,[40][41][42]44,45,[47][48][49][50][51][52][53]56 and 11 observational studies 16,17,20,35,36,38,39,43,46,54,55 were analyzed in a proportion-based meta-analysis for the various outcomes. One study was available only as protocol and abstract at the time of the analysis, therefore it was not included 13 .…”

“…There were no sub-group differences between LISA with sedation (ketamine, propofol, fentanyl, multiple drugs analyzed together, and rescue sedation) and LISA without sedation for the outcome IMV within 72 hours. The overall rate of IMV requirement within 72 hours in the whole LISA group was 25% (19%-31%) 5,6,16,17,20,[31][32][33][34][35][36][37][39][40][41][43][44][45][46][47][48][49][51][52][53][54][55] (Supplemental Figure S5).…”

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

“…They found that LISA had the same effect on BPD as traditional surfactant administration. A recent study involving 40 neonates with an average gestational age of 31 weeks also reported no effects of LISA on reducing BPD, as compared with InSurE [ 15 ]. This could possibly be associated with the lower incidence of BPD in infants with gestation age > 28 weeks.…”