Abstract
Background
Examine the real-world clinical impact of adopting less invasive surfactant administration (LISA) as the primary surfactant administration method in extremely preterm infants.
Methods
Single-center pre-post cohort study conducted over a 4-year period comparing outcomes of spontaneously breathing inborn infants 24+0–28+6 weeks gestational age (GA) receiving surfactant via endotracheal tube (pre-cohort, n = 154) or LISA via thin catheter (post-cohort, n = 70). Primary outcome was need for invasive mechanical ventilation (IMV, ≥2 h) ≤72 h of age. Secondary outcomes were a composite of mortality, bronchopulmonary dysplasia, intraventricular hemorrhage ≥grade 3 or necrotizing enterocolitis, and its individual components. Groups were compared using propensity score methods, including covariates: GA, birth weight, sex, small for GA, SNAP II ≥20, premature rupture of membranes, maternal hypertension/diabetes, and C-section.
Results
GA and birth weight were 27.1 (26, 28.1) weeks and 914 (230) g, and 27.1 (26.1, 28.1) weeks and 920 (236) g for pre- and post-cohorts, respectively. Pre-cohort had higher C-section rates, (67% vs. 51%, p = 0.03). After adjustment for covariates, LISA was associated with reduced IMV exposure [AOR (95% CI) 0.07 (0.04, 0.11)], lower odds of the composite clinical outcome [0.49 (0.33, 0.73)], and most of its individual components.
Conclusion
Real-world experience favors LISA as the primary method in extremely preterm infants with established spontaneous respiration.
Impact
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Less invasive surfactant administration (LISA) is associated with a reduction in respiratory morbidity, but real-world data of routine use among extremely preterm infants are limited.
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LISA is associated with reduced frequency of exposure to and duration of IMV in both ≤72 h after birth and during hospital stay.
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LISA is associated with a reduction in mortality, and most other major morbidities including bronchopulmonary dysplasia, and interventricular hemorrhage.
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Data from a large North American center providing real-world clinical outcomes following LISA as the primary method of surfactant administration.
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Data availability
The dataset generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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A.J. conceived the research question, conceptualized the initial study design and data collection forms, and revised the final draft of the manuscript. M.B. participated in the initial study design and data collection forms, collected in-hospital data for the study cohort, and produced the first draft of the manuscript. V.D. reviewed the study protocol, collected in-hospital data for the study cohort, reviewed the manuscript, and provided critical feedback. L.H. reviewed the study protocol, collected in-hospital data for the study cohort, reviewed the manuscript, and provided critical feedback. B.L. reviewed the study protocol, collected in-hospital data for the study cohort, reviewed the manuscript, and provided critical feedback. X.Y.Y. performed all statistical analysis for the study, reviewed the manuscript, and provided critical feedback. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Baczynski, M., Deekonda, V., Hamilton, L. et al. Clinical impact of less invasive surfactant administration using video laryngoscopy in extremely preterm infants. Pediatr Res 93, 990–995 (2023). https://doi.org/10.1038/s41390-022-02197-3
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DOI: https://doi.org/10.1038/s41390-022-02197-3
