Comparison Between Less Invasive Surfactant Administration (LISA) and Intubation-Surfactant-Extubation (InSurE) in Preterm Infants with Respiratory Distress Syndrome: A Retrospective Study

Abstract

Background: Bronchopulmonary dysplasia (BPD) is an important morbidity caused by neonatal lung injury due to mechanical ventilator use. Respiratory distress syndrome (RDS) is leading cause of mechanical ventilation in preterm infants. Surfactant was administrated through the endotracheal tube for management of RDS, which compels invasive mechanical ventilation. Recently, Intubation-SURfactant administration-Extubation (INSURE) and Less-invasive surfactant administration (LISA) have been introduced to avoid invasive mechanical ventilation. This study aimed to compare the effectiveness of LISA and INSURE.Methods: This single-center, retrospective study enrolled 47 newborns admitted to the neonatal intensive care unit (NICU) of the Wonju Severance Christian’s Hospital between January 1, 2017 and August 31, 2019, above a gestational age of 25 weeks, and required surfactant. The patient were divided into the LISA group and the INSURE group, and compared capillary gas analysis, oxygen saturation index (OSI), and morbidities.Results: The LISA group and the INSURE group included 34 and 13 newborns respectively. Demographic feature and OSI showed no significant differences between two groups. In the LISA group, pCO2 decreased over 1 hour(57.49±9.43mmHg), 2 hours(53.07±9.25mmHg, p=0.04) and 6 hours (46.50±8.53mmHg, p=0.01). pCO2 of the INSURE group decreased steeper within 2 hours (49.55±8.96mmHg to 39.56±6.20mmHg) in the INSURE group, however, the trend was not significant (p = 0.06). There were no significant differences in morbidities. Discussion: LISA and INSURE showed no significant differences in OSI and morbidities. Although LISA decreases pCO2 more slowly than INSURE, the difference is not statistical significant. LISA and INSURE are equally effective modalities for surfactant administration.

Surfactant administration in preterm babies (28–36 weeks) with respiratory distress syndrome: LISA versus InSurE, an open‐label randomized controlled trial

“…This could be attributed to similar rate of mechanical ventilation in both the groups. Similar findings were reported from other studies 25–28,31,32 . We found no significant difference in other secondary outcomes such as IVH, NEC, ROP, hsPDA, pneumothorax, and LOS between the groups.…”

“…As with our study, several other trials 25–32 found no significant difference between the InSurE and LISA groups about the need for intubation within 72 h of birth. Mohammadizadeh et al 26 conducted a multicentre RCT in Iran among 38 preterm babies below 34 weeks gestational age and found insignificant difference in the need for intubation within first 72 h of life.…”

“…In contrast, Olivier et al 45 and Mohamadizadeh et al 26 reported a statistically significant higher incidence of desaturation/bradycardia during the procedure, attributed to premedication for sedation before the procedure or inadequate training. Duration of hospital stay was also similar among the groups, comparable with other studies 2,25,31 . There was no statistically significant difference in the survival outcome between the groups (RR: 1.06, 95% CI: 0.76–1.57) 36,46 .…”

“…CPAP, continuous positive airway pressure; InSurE, intubate-surfactant-extubate; LISA, less invasive surfactant administration. The study population included preterm babies of a wider gestational age range [28][29][30][31][32][33][34][35][36] weeks with a mean gestational age of 31.4 weeks. It is comparable with other studies.…”

“…The study population included preterm babies of a wider gestational age range 28‐36 weeks with a mean gestational age of 31.4 weeks. It is comparable with other studies 27,32 .…”