Minimally invasive surfactant therapy failure: risk factors and outcome

Abstract

ObjectiveTo evaluate incidence of minimally invasive surfactant therapy (MIST) failure, identify risk factors and assess the impact of MIST failure on neonatal outcome.DesignRetrospective cohort study. MIST failure was defined as need for early mechanical ventilation (<72 hours of life). Multivariate logistic regression analysis was performed to identify risk factors for MIST failure and compare outcomes between groups.SettingTwo tertiary neonatal intensive care centres in the Netherlands.PatientsInfants born between 24 weeks’ and 31 weeks’ gestational age (GA) (n=185) with MIST for respiratory distress syndrome.InterventionsMIST procedure with poractant alfa (100–200 mg/kg).Main outcome measuresContinuous positive airway pressure (CPAP) failure after MIST in the first 72 hours of life.Results30% of the infants failed CPAP after MIST. In a multivariate logistic regression analysis, four risk factors were independently associated with failure: GA <28 weeks, C reactive protein ≥10 mg/L, absence of antenatal corticosteroids and lower surfactant dose. Infants receiving 200 mg/kg surfactant had a failure rate of 14% versus 35% with surfactant dose <200 mg/kg. Mean body temperature was 0.4°C lower at neonatal intensive care unit admission and before the procedure in infants with MIST failure.Furthermore, MIST failure was independently associated with an increased risk of severe intraventricular haemorrhage.ConclusionWe observed moderate MIST failure rates in concordance with the results of earlier studies. Absence of corticosteroids and lower surfactant dose are risk factors for MIST failure that may be modifiable in order to improve MIST success and patient outcome.

Neonatal Preterm Respiratory Care in Ukraine: An Observational Study of Outcomes in Relation to Timing and Methods of Surfactant Treatment

“…The incidence of CPAP failure below 30% in our patients treated with LISA or INSURE suggests that the latter technique if properly used could have acceptable effectiveness. The corresponding incidence of CPAP failure of 27% in our population of infants treated with LISA or INSURE was similar to the rate of 30% recently reported by Janssen et al 31 for the infants born between 24 and 31 weeks' gestational age and treated solely with minimally invasive surfactant administration. Like the authors of that study, we found significant associations between CPAP failure and such clinical variables as infants' gestational age, antenatal steroid prophylaxis, neonatal sepsis, and surfactant use.…”

Implementation of less invasive surfactant administration in clinical practice—Experience of a mid-sized country

“…LISA was used in 41% of infants requiring SF retreatment. This rate is similar to the 39% rate reported in a recent study by Janssen et al [21]. Nonetheless, we find it to be quite high for the implementation period.…”

2019 Year in Review: Neonatal Respiratory Support

“…59 These finding are consistent with previous meta-analyses that reported improved survival without adverse events for infants treated with TCA. [64][65][66][67][68] These data contribute to the growing body of evidence supporting the benefits of less invasive surfactant administration, which has been adopted in Europe as the preferred method of SRT for spontaneously breathing infants. 69 It is important to note that TCA is more commonly practiced in Europe and Australia.…”