Less Invasive Surfactant Administration in Extremely Preterm Infants: Impact on Mortality and Morbidity

Abstract

Background: A new mode of surfactant administration without intubation - less invasive surfactant administration (LISA) - has recently been described for premature infants. Objective: We report single-center outcome data of extremely premature infants who have been managed by LISA in our department. Mortality and morbidity rates of the cohort were compared to historical controls from our own center and to data of the Vermont-Oxford Neonatal Network (VONN). Patients and Methods: All infants born at 23-27 weeks' gestational age during 01/2009 and 06/2011 (n = 224) were managed by LISA and included in the study group. Results: LISA was tolerated by 94% of all infants. 68% of infants stayed on continuous positive airway pressure on day 3. The rate of mechanical ventilation was 35% within the first week and 59% during the entire hospital stay. Compared to historical controls, we found significantly higher survival rates (75.8 vs. 64.1%) and significantly less intraventricular hemorrhage (IVH) (28.1 vs. 45.9%), severe IVH (13.1 vs. 23.9%) and cystic periventricular leukomalacia (1.2 vs. 5.6%); only persistent ductus arteriousus (PDA) (74.7 vs. 52.6%) and retinopathy of prematurity (ROP) (40.5 vs. 21.1%) occurred significantly more often. Compared to VONN data, we found significantly less chronic lung disease (20.6 vs. 46.4%), severe cerebral lesions (IVH 3/4 + cystic PVL; 9.4 vs. 16.1%) and ROP (all grades) (40.5 vs. 56.5%); only PDA (74.7 vs. 63.1%) and severe ROP (> grade 2) (24.1 vs. 14.1%) occurred significantly more often in our cohort. Conclusion: Surfactant can be effectively and safely delivered via LISA and this is associated with low rates of mechanical ventilation and various adverse outcomes in extremely premature infants.

Effects of less-invasive surfactant administration on oxygenation, pulmonary surfactant distribution, and lung compliance in spontaneously breathing preterm lambs

“…The techniques of LISA to spontaneous breathing infants were introduced into the clinical practice without experimental evaluation (8,9,11). To our knowledge, this is the first study to investigate oxygenation, gas exchange, pulmonary surfactant distribution, and lung compliance in preterm lambs that either exclusively received CPAP, received LISA or were intubated and mechanically ventilated with surfactant administration.…”

“…This technique proved to be feasible in clinical practice with first attempt success rate above 80% (8)(9)(10). This technique was referred to as minimally invasive surfactant therapy (8) or less-invasive surfactant administration (LISA) (9).…”

Probiotics (Lactobacillus acidophilus and Bifidobacterium bifidum) prevent NEC in VLBW infants fed breast milk but not formula

“…It is however a limitation that we do not have the data on the use of pentoxifylline in all study infants. Furthermore, a way of less invasive surfactant application was established that improved the survival of infants <26 wk GA and reduced severe IVH (29) and was accompanied by improvements in physician's staffing which itself has a known impact on patient's mortality (30). Overall, we conclude that reduced morbidities and improvements in the management of VLBW infants-not probiotics alone-have significantly reduced mortality in our cohort.…”

The possibility of reducing mortality in the neonatal intensive care unit

“…были опубликованы результаты внедрения про-токола постнатального ведения новорожденных, названного LISA (Less Invasive Surfactant Administration -малоинвазивное введение сурфак-танта) и включающего раннее высокопоточное CPAP (Continuous Positive Airway Pressure -метод постоянного положительного давления в дыхатель-ных путях) и терапию сурфактантом через тонкий катетер, введенный в трахею, для всех новорожден-ных, родившихся на сроке 27-28 недель гестацион-ного возраста [3]. Методика оказалась безопасной и позволила снизить летальность и заболеваемость.…”