Surfactant treatment rate in very premature infants following change to less-invasive surfactant administration

Abstract

This study investigates whether implementation of a less-invasive surfactant administration (LISA) protocol in a level IIIb academic neonatal intensive care unit had an impact on the rate of infants treated with surfactant. This observational cohort study enrolled spontaneously breathing very premature infants, born < 33 weeks’ gestational age (GA), with worsening respiratory distress syndrome despite support with continuous positive airway pressure and in need of surfactant replacement therapy. Data were collected over two 3-year periods, preceding (P1, 2013–2015) and following (P2, 2019–2021) implementation of a LISA protocol. Nine hundred and six neonates were studied, 412 (45%) born in P1 and 494 (55%) in P2, with comparable GA, birthweight, and severity score (CRIB-II). Administration technique was mainly conventional at P1 (85%) and LISA at P2 (75%). Surfactant treatment rate decreased from 54% (224/412) at P1 to 47% (233/494) at P2 (p = 0.04), notably in infants born at 28–32 weeks’ GA (41 to 33%, OR [95% CI] 0.72 [0.53–0.99]). Among 23–32 weeks’ GA infants, need for invasive mechanical ventilation decreased from 56% (231/412) at P1 to 23% (113/494) at P2 (OR 0.23 [0.17–0.31], p < 0.001). Mortality and survival without severe morbidity were comparable. Conclusion: Implementation of a LISA protocol in our level IIIb NICU was associated with less surfactant use and lower exposure to invasive mechanical ventilation.