222 - Comparison of infants <28 weeks and >28 weeks requiring surfactant administration through two different techniques: Less Invasive Surfactant Administration vs INtubation-Surfactant-Extubation

Poster Number: 222
Publication Number: 222.2787

Background: Surfactant administration decreased mortality and complications associated with respiratory distress syndrome (RDS) in premature infants. The INtubation-SURfactant-Extubation (INSURE) method requires intubation, giving surfactant through an endotracheal tube and a period of invasive mechanical ventilation. More recently, give surfactant via Less Invasive Surfactant Administration (LISA) which uses a thin catheter and doesn't require endotracheal intubation.

Objective: The purpose of our study was to perform subgroup analyses comparing adverse events and outcomes of LISA vs INSURE for infants ≤28 weeks and >28 weeks gestational age.

Design/Methods: This is a retrospective (2016 to 2023) cohort study of neonates admitted to a Level III Neonatal Intensive Care Unit who received surfactant administration via LISA or INSURE. Data was abstracted from the NICU database and electronic health records, and analyzed using SPSS version 29.

Results: There were 135 infants included in this study. 71 (53%) received surfactant administration via INSURE; 64 (47%) received surfactant administration via LISA. Infant characteristics were similar in both groups. Lisa was successfully performed in majority of patients in both ≤28 weeks and >28 weeks. Infants ≤28 weeks had a higher risk of CPAP failure with INSURE compared to LISA (65% vs 20%, p=0.01) and were significantly more likely to get BPD (90%) compared to the LISA group (31%), p< 0.01. Pulmonary morbidities were higher in the first year of life for infants receiving surfactant with INSURE compared to LISA techniques (47% vs 8%, p=0.02). In infants >28 weeks, the need for mechanical ventilation after surfactant was significantly higher in the LISA group (70%) compared to the INSURE group (30%), p=0.03.The infants receiving surfactant using INSURE were more likely to remain intubated at 3 days and at 7 days and were significantly more likely to get BPD (25%) compared to the LISA group (7%), p=0.02. Though surfactant administration via LISA had significantly more complications (13%) when compared to INSURE (2%), p=0.04.

Conclusion(s): Our preliminary data showed that infants ≤28 weeks receiving surfactant using LISA technique have decreased risk of short term and long term pulmonary morbidities. Infants < 28 weeks may benefit from surfactant administration using LISA in short term with decreased risk of mechanical ventilation. Care must be taken in these infants while administering surfactant with LISA to decrease procedure related complications. Collection of data is ongoing to determine other factors of significance and to verify these results in a larger sample size.