Neonatal-Perinatal Medicine Fellow Stanford University School of Medicine Sunnyvale, California, United States
Background: In randomized controlled trials, less invasive surfactant administration (LISA) has been associated with a reduction in the need for intubation as well as reduction in bronchopulmonary dysplasia (BPD) in premature infants. In smaller studies, surfactant administration through a laryngeal supraglottic airway (SALSA) has been shown to be feasible and reduce the need for intubation. Objective: We seek to implement both minimally invasive surfactant therapies (MIST) methods in a Level IV neonatal intensive care unit (NICU). Our SMART aim is to reduce the need for intubation within the first 72 hours of life in extremely preterm infants by 20% by April 2024. Design/Methods: This project will take place in our level IV NICU with approximately 95 inborn very low birth weight infants annually. As a quality improvement project, this study is exempt from the Institutional Review Board. Our project implementation methods included sharing best practices, physician and nurse practitioner education through didactics and simulation sessions, and nursing and respiratory therapy education. The target population will be inborn infants between 25-32 weeks estimated gestational age admitted to the Level IV NICU. Infants will be excluded if the indication for intubation is apnea or craniofacial anomalies. The prevalence of intubation in the first 72 hours will be compared between a historical epoch from January 2022-August 2023 and November 2023-March 2024 after implementation. Rates of death, BPD, and severe IVH will be compared as secondary outcomes. Balancing measures will include adverse events during the MIST procedure, including the need for emergent intubation. MIST will be implemented in our unit in November 2023. Chi-square tests will be performed for categorical variables and t-tests will be performed for continuous variables.
