388 - Outcomes Of Infants In The Neonatal Intensive Care Unit Undergoing Multiple Attempts Of Intracheal Surfactant Administration

Poster Number: 388
Publication Number: 388.2924

Background: Surfactant can decrease mortality and complications associated with respiratory distress syndrome (RDS) in premature infants. The most common method is the INtubation-SURfactant-Extubation (INSURE) method, which requires intubation, giving surfactant through an endotracheal tube and a brief period of invasive mechanical ventilation. We recently changed our practice of surfactant administration to Less Invasive Surfactant Administration (LISA) which uses a thin catheter and does not require intubation.

Objective: To compare characteristics and outcomes of infants who successfully received surfactant in a single attempt versus multiple attempts of INSURE and LISA.

Design/Methods: This is a retrospective (2016 to 2023) cohort study of infants admitted to the Neonatal Intensive Care Unit (NICU) at a single site who received surfactant via LISA or INSURE. Data was sourced from the NICU database or electronic health records, and analyzed using SPSS version 29. Infants were divided into two groups based on a single or multiple (>1) attempts of surfactant administration.

Results: 135 infants were included in this study. 71/135 (53%) underwent INSURE and 64/135 (47%) underwent LISA. 35/135 (26%) of infants required multiple doses of surfactant with 16/35 (46%) receiving LISA and 19/25 (54%) receiving INSURE. There was no significant difference based on infant demographics, mode of delivery, delivery interventions, or maternal antenatal steroids. There was a significantly higher rate of complications in infants with multiple attempts of surfactant administration (20%, p< 0.01), including airway trauma (43%), bradycardia (14%) and desaturations requiring positive pressure ventilation (43%). Complications after multiple attempts were more likely with LISA than INSURE (p < 0.01). Infants that required multiple doses of surfactant spent significantly longer time on invasive ventilation after the first dose of surfactant (mean 7 days vs 4 days, p=0.02). There were no significant differences in length of stay or rates of bronchopulmonary dysplasia, intraventricular hemorrhage, patent ductus arteriosis, or pneumothorax across groups.

Conclusion(s): Our preliminary data shows that infants receiving multiple attempts of surfactant administration had higher rates of procedural complications, such as trauma, bradycardia, or desaturations, and increased requirement of invasive ventilation after the first dose. Multiple procedural attempts did not lead to any long term morbidities. Data collection is ongoing to determine other factors of significance and to verify these results in a larger sample size.