Short-Term Outcome after Repeated Less Invasive Surfactant Administration: A Retrospective Cohort Study

Abstract

<b><i>Introduction:</i></b> Less invasive surfactant administration (LISA) to preterm infants is associated with decreased risk for death or BPD. After LISA, a considerable proportion requires a second dose of surfactant because of ongoing respiratory distress syndrome, raising a clinical dilemma between intubation or performing a repeated LISA (re-LISA) procedure. We aim to assess efficacy of re-LISA in avoiding subsequent nasal continuous positive airway pressure failure (need for intubation in the first 72 h of life; CPAP-F), to identify factors associated with subsequent CPAP-F, and to compare short-term outcomes following re-LISA to surfactant retreatment by endotracheal intubation and mechanical ventilation. <b><i>Methods:</i></b> This was an observational retrospective study in two Dutch NICUs. Inclusion criterion was infants with gestational age <32 0/7 weeks requiring a second surfactant dose. Multivariate logistic regression analysis was performed. <b><i>Results:</i></b> Of 209 infants requiring second surfactant dose, 132 received re-LISA. Subsequent CPAP-F was observed in 56 (42%) infants and was associated with extreme prematurity (OR 2.6, 95% CI: 1.2–5.8) and FiO<sub>2</sub>>0.5 (OR 5.4, 95% CI: 2.0–14.7). Infants receiving re-LISA had a lower risk of death or BPD compared to infants intubated for the second surfactant dose (OR 0.4, 95% CI: 0.2–0.9). Infants with CPAP-F after re-LISA had similar outcomes compared to those intubated for second surfactant dose. <b><i>Conclusion:</i></b> Re-LISA is effective in reducing CPAP-F and is associated with lower risk of death or BPD compared to retreatment via an endotracheal tube. Infants failing CPAP after re-LISA have similar outcomes compared to intubated infants. These findings support the use of re-LISA in preterm infants with ongoing RDS.

Prevention of Chronic Morbidities in Extremely Premature Newborns with LISA-nCPAP Respiratory Therapy and Adjuvant Perinatal Strategies

“…With a post hoc analysis of their prospective cohort study, Kruczek et al found that FiO 2 was an independent risk factor for LISA failure [ 63 ], while Ramos-Navarro et al noticed that a reduction in FiO 2 after LISA was a predictor of treatment success (defined as no need for intubation during the first 72 h of life) [ 62 ]. In their retrospective observational study, investigating the short-term outcome after repeated LISA (reLISA), Kleijkers et al found that reLISA is effective in reducing CPAP failure, and is associated with a lower risk of death or BPD compared to retreatment via an endotracheal tube [ 64 ]. One of the most important questions regarding the use of LISA is how to identify preterm infants whose RDS can be successfully treated with a single LISA.…”