Introduction of less invasive surfactant administration (LISA), impact on diagnostic and therapeutic procedures in early life: a historical cohort study

• Published in: BMC pediatrics Vol. 20; no. 1; p. 421
• Main Authors: Bugter, I A L, Janssen, L C E, Dieleman, J, Kramer, B W, Andriessen, P, Niemarkt, H J
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 03-09-2020; BioMed Central; BMC
• Subjects: Antibiotics; Avoidance of mechanical ventilation; Blood transfusion; Blood transfusions; Catheters; Cohort analysis; Cohort Studies; Comparative analysis; Diagnostic tests; Drug dosages; Dysplasia; Enteral nutrition; Gestational age; Health aspects; Humans; Infant; Infant, Newborn; Infant, Premature; Intubation; Less invasive surfactant administration (LISA); Medical diagnosis; Minimally invasive surfactant therapy (MIST); Newborn babies; Pediatrics; Population; Premature infants; Preterm; Respiration, Artificial; Respiratory distress syndrome; Respiratory distress syndrome (RDS); Respiratory Distress Syndrome, Newborn - diagnosis; Respiratory Distress Syndrome, Newborn - therapy; Respiratory system agents; Retrospective Studies; Statistical analysis; Surface active agents; Surfactant; Surfactants; Treatment Outcome; Ventilators; X-rays; Italy; Avoidance of mechanical ventilation; Less invasive surfactant administration (LISA); Minimally invasive surfactant therapy (MIST); Surfactant; Respiratory distress syndrome (RDS); Preterm
• DOI: 10.1186/s12887-020-02325-0
• EISSN: 1471-2431

In preterm infants with Respiratory Distress Syndrome (RDS), Less Invasive Surfactant Administration (LISA) has been established to reduce the need of mechanical ventilation and might improve survival rates without bronchopulmonary dysplasia. The aim of this study was to investigate whether NICU care has changed after introduction of less invasive surfactant administration (LISA), with regard to diagnostic and therapeutic procedures in the first week of life.
Infants with gestational age < 32 weeks who received surfactant by LISA (June 2014 - December 2017, n = 169) were retrospectively compared to infants who received surfactant after intubation (January 2012 - May 2014, n = 155). Local protocols on indication for surfactant, early onset sepsis, blood transfusions and enteral feeding did not change between both study periods. Besides, as secondary outcome complications of prematurity were compared. Data was collected from electronic patient files and compared by univariate analysis through Students T-test, Mann Whitney-U test, Pearson Chi-Square test or Linear by Linear Association.
All baseline characteristics of both groups were comparable. Compared to controls, LISA patients received a higher total surfactant dose (208 vs.160 mg/kg; p < 0.001), required redosing more frequently (32.5% vs. 21.3%; p = 0.023), but needed less mechanical ventilation (35.5% vs. 76.8%; p < 0.001). After LISA, infants underwent fewer X-rays (1.0 vs. 3.0, p < 0.001), blood gas examinations (3.0 vs. 5.0, p < 0.001), less inotropic drugs (9.5% vs. 18.1%; p = 0.024), blood transfusions (24.9% vs. 41.9%, p = 0.003) and had shorter duration of antibiotic therapy for suspected early onset sepsis (3.0 vs. 5.0 days, p < 0.001). Moreover, enteral feeding was advanced faster (120 vs. 100 mL/kg/d, p = 0.048) at day seven. There were no differences in complications of prematurity.
The introduction of LISA is associated with significantly fewer diagnostic and therapeutic procedures in the first week of life, which emphasizes the beneficial effects of LISA.