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

Abstract

Aim National survey to evaluate the uptake of Less Invasive Surfactant Administration (LISA) in neonatal units across England. Methods A web‐based survey was sent out by email to all 150 neonatal units in England. It consisted of questions regarding indications for LISA, the practicalities of the procedure and reasons for not using this technique. Results The response rate was 96% (144/150 units). Only 11% of units are using LISA, but majority (78%) would consider implementing LISA on their unit. 56% would also consider LISA on delivery suite. Challenges identified are having a guideline and staff training. 61% of units have set the target population ≥27 weeks. On sub‐analysis, for tertiary units, the trend for LISA is ≥26 weeks. The median FiO2 threshold for LISA is 0.3 (IQR 0.3‐0.4) in less than 28 weeks gestational age (GA), and 0.4 in higher gestations. The most common suggestion for premedication is fentanyl (32%). Conclusion The uptake of LISA in England is low comparing to the rest of Europe. Even though many units are considering implementing LISA, there is lack of training and national guidelines. There is urgent need for standardisation of practice and clear indications for LISA.

Systematic review found that using thin catheters to deliver surfactant to preterm neonates was associated with reduced bronchopulmonary dysplasia and mechanical ventilation

“…Studies assessing the effectiveness of LISA/SURE techniques in neonates on heated humidified high-flow therapy are lacking and this may be of relative importance, especially to centres that rely on this non-invasive ventilation mode 42,43. This aspect, together with the urgent need for standardisation of practice and clear indications, may account for the patchy uptake of this technique in some countries 44. Most of the authors in our review opted out of administering premedication before the procedure, as it may have interfered with cardiovascular function and the respiratory effort, both of which may be essential for this method to work.…”

Implementation of less invasive surfactant administration in clinical practice—Experience of a mid-sized country

“…To our knowledge, this is the first study exploring the process of a practically de novo implementation of LISA in everyday practice at a country level. LISA is an interesting example of a medical technology that is adequately backed by medical evidence showing its superiority over SF administration via endotracheal tube [13,14], yet its implementation remains problematic at bedside, and adoption rates are disappointing in many countries [8,9]. This study included an assessment of the learning process and the rate of LISA adoption-aspects that have not been investigated before.…”

“…Despite the significant number of neonatal units involved, data obtained may not be representative for all Polish centers and LISA uptake varied largely between them. Nonetheless, the mean use of LISA (24%) was higher than in the USA [8] or England [9], although lower than in Nordic countries [16], Germany [6] or Spain [10]. Comparison of the available literature data may be ambiguous since it is not obvious how the percentage of "units which use LISA" translates into the actual percentage of infants treated with LISA.…”

“…With increasing evidence of clinical benefits, LISA is becoming more widespread; however, its adoption is quite different in various regions of the world. Based on recent reports, routine use of this method is declared by only 8% of neonatologists in the USA [8] and 11% of neonatal units in England [9]. In other countries, such as Germany or Spain, LISA already seems to be the dominant method of surfactant administration [6,10].…”

Minimally Invasive Surfactant Therapy: An Analytical Report of Our Prospective Dubai Cohort

“…It has to be noted that whilst European units are the leaders in the implementation of this minimally or less invasive way of surfactant administration acceptance and adaption of this technology in care practices is lower in other countries like Japan, USA, and the United Kingdom. In a 2019 Web-based survey of 150 neonatal units in England it was reported that only 11% are using LISA for surfactant therapy [28]. Nevertheless 78% of the units were considering implementation of LISA after the bottlenecks of lack of adequate skill levels of the care givers and incorporation in clinical care guidelines are addressed to [28].…”