WIP 10 - Improving the percentage of preterm infants receiving surfactant via less invasive administration routes at a level IV NICU: A Quality Improvement Initiative

Poster Number: WIP 10
Publication Number: WIP 10.2569

Background: Preterm infants are at high risk for respiratory distress syndrome given their lung immaturity and insufficient surfactant production. Many infants are intubated for surfactant administration and subsequently receive mechanical ventilation. While early surfactant reduces morbidities and mortality in preterm infants, intubation with mechanical ventilation is associated with an increased risk of adverse events as well as bronchopulmonary dysplasia (BPD). Both INtubate-SURfactant-Extubate (INSURE) and less invasive surfactant administration (LISA) techniques allow for surfactant delivery while minimizing the need for mechanical ventilation and positive pressure ventilation. In our NICU most preterm infants requiring surfactant are intubated and placed on mechanical ventilation.

Objective: We aim to increase the percentage of preterm infants born between 25w0d to 31w6d who receive surfactant either via INSURE or LISA technique from 18% to 50% over a two-year period (Nov 2022-2024) at our level IV tertiary care NICU.

Design/Methods: We conducted a chart review from Jan 2020 to Oct 2022 to determine the baseline percentage of infants who received INSURE (LISA not yet implemented). Using the Institute for Healthcare Improvement’s Model for Improvement, key drivers were determined with a multidisciplinary team. Given that all stakeholders felt more comfortable with INSURE procedure at the time of initiation, our first interventions targeted increasing INSURE use. Simultaneously, we developed interventions with the goal of eventually implementing LISA. Our primary outcome measure is the percentage of infants who received surfactant by INSURE or LISA procedure. Secondary outcome measure is the percentage of infants maintained on non-invasive respiratory support. Balancing measures include intubation within 24 hours after administration and complications during either procedure. Interventions to increase INSURE procedure started Nov 2022 and interventions to implement LISA started Oct 2023. Data collection is ongoing and reported using statistical process control charts.