Observational Study on Less Invasive Surfactant Administration (LISA) in Preterm Infants&lt;29 Weeks – Short and Long-term Outcomes

Teig, Norbert; Weitkämper, A; Rothermel, J; Bigge, N; Lilienthal, Eggert; Rößler, L.; Hamelmann, Eckard

doi:10.1055/s-0035-1547295

Cited by 28 publications

(31 citation statements)

References 25 publications

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“…The survival rate and disability-free rate in the intervention group tended to be higher than in the control group. Teig et al68) also published a 36-month follow-up of infants treated with MIST. This study showed that the intervention group performed better on the Bayley Scales Mental Developmental Index and Psychomotor Developmental Index than a historical control group.…”

Section: Problems To Be Solved In the Futurementioning

confidence: 99%

Update of minimally invasive surfactant therapy

Shim

2017

Korean J Pediatr

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To date, preterm infants with respiratory distress syndrome (RDS) after birth have been managed with a combination of endotracheal intubation, surfactant instillation, and mechanical ventilation. It is now recognized that noninvasive ventilation (NIV) such as nasal continuous positive airway pressure (CPAP) in preterm infants is a reasonable alternative to elective intubation after birth. Recently, a meta-analysis of large controlled trials comparing conventional methods and nasal CPAP suggested that CPAP decreased the risk of the combined outcome of bronchopulmonary dysplasia or death. Since then, the use of NIV as primary therapy for preterm infants has increased, but when and how to give exogenous surfactant remains unclear. Overcoming this problem, minimally invasive surfactant therapy (MIST) allows spontaneously breathing neonates to remain on CPAP in the first week after birth. MIST has included administration of exogenous surfactant by intrapharyngeal instillation, nebulization, a laryngeal mask, and a thin catheter. In recent clinical trials, surfactant delivery via a thin catheter was found to reduce the need for subsequent endotracheal intubation and mechanical ventilation, and improves short-term respiratory outcomes. There is also growing evidence for MIST as an alternative to the INSURE (intubation-surfactant-extubation) procedure in spontaneously breathing preterm infants with RDS. In conclusion, MIST is gentle, safe, feasible, and effective in preterm infants, and is widely used for surfactant administration with noninvasive respiratory support by neonatologists. However, further studies are needed to resolve uncertainties in the MIST method, including infant selection, optimal surfactant dosage and administration method, and need for sedation.

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Section: Problems To Be Solved In the Futurementioning

confidence: 99%

Update of minimally invasive surfactant therapy

Shim

2017

Korean J Pediatr

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“…In brief, the INSURE method and LISA, using either an NT or a LISAcath® catheter, are different ways of delivering SF that all provide effective therapies. Further, although a one‐off perturbation of cerebral oxygenation was observed in INSURE and LISA groups during SF administration, it was short, and no significant changes in the brain were detected in histological analysis …”

Section: Discussionmentioning

confidence: 99%

Cerebral oxygenation associated with INSURE versus LISA procedures in surfactant‐deficient newborn piglet RDS model

Rey-Santano

Mielgo

Gomez-Solaetxe

et al. 2019

Pediatric Pulmonology

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Background Nasal continuous‐positive airway pressure (nCPAP) with the INSURE (INtubation‐SURfactant‐Extubation) or LISA (Less‐Invasive Surfactant Administration) procedures are increasingly being chosen as the initial treatment for neonates with surfactant deficiency. Our objective was to compare the effects on cerebral oxygenation of different methods for surfactant administration: INSURE and LISA, using a nasogastric tube (NT) or a LISAcath® catheter, in spontaneously breathing SF‐deficient newborn piglets. Methods Eighteen newborn piglets with SF‐deficient lung injury produced by repetitive bronchoalveolar lavages were randomly assigned to INSURE, LISA‐NT, or LISAcath® groups. We assessed pulmonary (gas exchange, lung mechanics, lung histology) and hemodynamic (mean arterial blood pressure, heart rate) changes, cerebral oxygenation (cTOI) and cerebral fractional tissue extraction (cFTOE), with near‐infrared spectroscopy, carotid blood flow and brain histology. Results SF‐deficient piglets developed respiratory distress (FiO2 = 1, pH <7.2, PaCO2 >70 mmHg, PaO2 <70 mmHg, Cdyn <0.5 mL/cmH2O/kg). Rapid improvements in pulmonary status were observed in all surfactant‐treated groups without hemodynamic alterations. In the INSURE group, a transient decrease in cTOI occurred during and immediately after surfactant administration, while cTOI only decreased during surfactant administration in the LISA‐NT group and did not change significantly in the LISAcath® group. Brain injury scores were low in all surfactant‐treated groups. Conclusion In spontaneously breathing SF‐deficient newborn piglets, short‐lasting decreases in cerebral oxygenation are associated with surfactant administration by the INSURE method or LISA using an NT, while no cerebral oxygenation changes occurred with LISA using a LISAcath®. Notably, none of treatments studied seems to have a negative impact on the neonatal brain.

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“…The meta‐analyses showed that there were no significant differences in the incidences of IVH, PVH, NEC, or ROP between the two groups, while thin catheter administration appeared to reduce the mortality rate, primarily in observational historical controlled trials. Two observational trials reported neurodevelopmental follow‐up outcomes, indicating no significant difference between the groups; however, both of them failed to achieved ≥80% follow‐up and had high risk due to incomplete outcome data.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with the conventional method, thin catheter administration of surfactant reduced the need for invasive methods and MV, and also reduced the incidence of BPD. A series of trials with small sample sizes were conducted but, owing to the limited statistical power and the infants’ heterogeneous conditions, the results of these trials were inconsistent. Therefore, we performed a meta‐analysis of all controlled trials to systematically review the clinical outcomes of surfactant administration via a thin catheter in preterm infants.…”

Section: Introductionmentioning

confidence: 99%

Surfactant administration via a thin endotracheal catheter during spontaneous breathing in preterm infants

Shi

et al. 2017

Pediatric Pulmonology

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To systematically review the clinical outcomes of surfactant administration via a thin endotracheal catheter during spontaneous breathing compared with conventional administration involving tracheal intubation, mechanical ventilation (MV), and tracheal extubation, in preterm infants. PubMed, EMBASE, and the Cochrane Library were searched to identify relevant clinical trials. Data were analyzed using the Cochrane Collaboration methods. Primary outcome measures included the incidence of MV and bronchopulmonary dysplasia (BPD). Finally, four RCTs, two prospective cohort trials, and six historical controlled trials involving 5,261 preterm infants were analyzed. In RCTs, surfactant administration though a thin catheter reduced the incidence of MV (risk ratio [RR]: 0.74; 95% confidence interval [CI]: 0.66, 0.81) in 72 hr and BPD (RR: 0.69, 95%CI: 0.50, 0.97) compared with conventional administration and in non-RCTs, there was also significant reduction in the incidence of MV (RR: 0.55, 95%CI: 0.45, 0.68) and BPD (RR: 0.70, 95%CI: 0.60, 0.82) in favor of the thin catheter group. There were no significant differences between the two procedures in terms of short-term pulmonary complications, intracranial pathology, necrotizing enterocolitis, retinopathy of prematurity, and mortality. Thus, surfactant administration via a thin endotracheal catheter to preterm infants has promising benefits, including reducing the incidences of MV and BPD, while providing comparable breathing support to conventional administration in MV. Pediatr Pulmonol. 2017; 52:844-854. © 2017 Wiley Periodicals, Inc.

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Observational Study on Less Invasive Surfactant Administration (LISA) in Preterm Infants<29 Weeks – Short and Long-term Outcomes

Cited by 28 publications

References 25 publications

Update of minimally invasive surfactant therapy

Update of minimally invasive surfactant therapy

Cerebral oxygenation associated with INSURE versus LISA procedures in surfactant‐deficient newborn piglet RDS model

Surfactant administration via a thin endotracheal catheter during spontaneous breathing in preterm infants

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