Article | Published:

The use of less invasive surfactant administration (LISA) in the United States with review of the literature

Journal of Perinatologyvolume 39pages426432 (2019) | Download Citation

Abstract

Background

The majority of extremely low gestational age neonates undergo intubation for surfactant therapy. Less invasive surfactant administration (LISA) uses a thin catheter inserted into the trachea to deliver the surfactant. During the procedure, the infant is breathing spontaneously while supported with continuous positive airway pressure. Although LISA is widely adapted in Europe and Australia, the rate of LISA use in the United States is unknown.

Study design

The aim of this study is to evaluate the use of LISA in the US. A web-based survey was distributed via SurveyMonkey to 2550 neonatologists from AAP’s SoNPM mailing list.

Results

Of the 472 neonatologists who answered the survey, 15% used LISA either as a part of routine care (8%) or as part of research (7%).

Conclusion

Unlike several regions of Europe, LISA is not widely used in the US. Future studies should address ambiguities regarding infant selection, procedure training and “roadblocks” to its broader application.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

  1. 1.

    Hillman NH, Kallapur SG, Pillow JJ, Moss T, Polglase G, et al. Airway injury from initiating ventilation in preterm sheep. Pediatr Res. 2010;67:60–5.

  2. 2.

    Hillman NH, Moss TJ, Kallapur SG, Bachurski C, Pillow JJ, et al. Brief, large tidal volume ventilation initiates lung injury and a systemic response in fetal sheep. Am J Respir Crit Care Med. 2007;176:575–81.

  3. 3.

    Stevens TP, Harrington EW, Blennow M, Soll RF. Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Syst Rev. 2007;CD003063.

  4. 4.

    Kribs A, Pillekamp F, Hünseler C, Vierzig A, Roth B. Early administration of surfactant in spontaneous breathing with nCPAP: feasibility and outcome in extremely premature infants (postmenstrual age</=27 weeks). Paediatr Anaesth. 2007;17:364–9.

  5. 5.

    Kribs A, Härtel C, Kattner E, Vochem M, Kuster H, Moller J, et al. Surfactant without intubation in preterm infants with respiratory distress: first multi-center data. Klin Padiatr. 2010;222:13–7.

  6. 6.

    Göpel W, Kribs A, Ziegler A, Laux R, Hoehn T, Wieg C, et al. Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. Lancet. 2011;378:1627–34.

  7. 7.

    Dargaville PA, Aiyappan A, Cornelius A, Williams C, De Paoli AG. Preliminary evaluation of a new technique of minimally invasive surfactant therapy. Arch Dis Child Fetal Neonatal Ed. 2011;96:F243–8.

  8. 8.

    Kribs A, Vierzig A, Hünseler C, Eifinger F, Welzing L, Stützer, et al. Early surfactant in spontaneously breathing with nCPAP in ELBW infants: a single centre four year experience. Acta Paediatr. 2008;97:293–8.

  9. 9.

    Dargaville PA, Aiyappan A, De Paoli AG, Kuschel CA, Kamlin CO, Carlin JB, et al. Minimally-invasive surfactant therapy in preterm infants on continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed. 2013;98:F122–6.

  10. 10.

    Mehler K, Grimme J, Abele J, Huenseler C, Roth B, Kribs A, et al. Outcome of extremely low gestational age newborns after introduction of a revised protocol to assist preterm infants in their transition to extrauterine life. Acta Paediatr. 2012;101:1232–9.

  11. 11.

    Klebermass-Schrehof K, Wald M, Schwindt J, Grill A, Prusa AR, Haiden N, et al. Less invasive surfactant administration in extremely preterm infants: impact on mortality and morbidity. Neonatology. 2013;103:252–4.

  12. 12.

    Verder H, Agertoft L, Albertsen P, Christensen NC, Curstedt T, Ebbesen F, et al. Surfactant treatment of newborn infants with respiratory distress syndrome primarily treated with nasal continuous positive air pressure. A pilot study. Ugeskr Laeger. 1992;154:2136–9.

  13. 13.

    Kanmaz HG, Erdeve O, Canpolat FE, Mutlu B, Dilmen U. Surfactant administration via thin catheter during spontaneous breathing: randomized controlled trial. Pediatrics. 2013;131:e502–9.

  14. 14.

    Heidarzadeh M, Mirnia K, Hoseini MB, Sadeghnia A, Akrami F, Balila M, et al. Surfactant administration via thin catheter during spontaneous breathing: randomized controlled trial in Alzahra hospital. Iran J Neonatol. 2013;4:5–9.

  15. 15.

    Aguar M, Cernada M, Brugada M, Gimeno A, Gutierrez A, Vento M, et al. Minimally invasive surfactant therapy with a gastric tube is as effective as the intubation, surfactant, and extubation technique in preterm babies. Acta Paediatr. 2014;103:e229–33.

  16. 16.

    Kribs A, Roll C, Göpel W, Wieg C, Groneck P, Laux R, et al. Nonintubated surfactant application vs conventional therapy in extremely preterm infants: a randomized clinical trial. JAMA Pediatr. 2015;169:723–30.

  17. 17.

    Mohammadizadeh M, Ardestani AG, Sadeghnia AR. Early administration of surfactant via a thin intratracheal catheter in preterm infants with respiratory distress syndrome: feasibility and outcome. J Res Pharm Pract. 2015;4:31–6.

  18. 18.

    Bao Y, Zhang G, Wu M, Ma L, Zhu J. A pilot study of less invasive surfactant administration in very preterm infants in a Chinese tertiary center. BMC Pediatr. 2015;15:21.

  19. 19.

    Krajewski P, Chudzik A, Strzałko-Głoskowska B, Górska M, Kmiecik M, Więckowska K, et al. Surfactant administration without intubation in preterm infants with respiratory distress syndrome--our experiences. J Matern Fetal Neonatal Med. 2015;28:1161–4.

  20. 20.

    Göpel W, Kribs A, Härtel C, Müller T, Jorch G, Felderhoff-Müser U, et al. Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants. Acta Paediatr. 2015;104:241–6.

  21. 21.

    Canals Candela FJ, Vizcaíno Díaz C, Ferrández Berenguer MJ, Serrano Robles MI, Vázquez Gomis C, Quiles Durá JL, et al. Surfactant replacement therapy with a minimally invasive technique: Experience in a tertiary hospital. An Pediatr (Barc). 2016;84:79–84.

  22. 22.

    Ramos-Navarro C, Sánchez-Luna M, Zeballos-Serato S, González-Pacheco N. Less invasive beractant administration in preterm infants: a pilot study. Clinics (Sao Paulo). 2016;71:128–34. https://doi.org/10.6061/clinics/2016(03)02.

  23. 23.

    Arroe M, Pedersen-Bjergaard L, Albertsen P, Bode S, Greisen G, Jonsbo F, et al. Inhalation of aerosolized surfactant (Exosurf1) to neonates treated with nasal continuous positive airway pressure. Prenat Neonat Med. 1998;3:346–52.

  24. 24.

    Berggren E, Liljedahl M, Winbladh B, Andreasson B, Curstedt T, Robertson B, et al. Pilot study of nebulized surfactant therapy for neonatal respiratory distress syndrome. Acta Paediatr. 2000;89:460–4.

  25. 25.

    Jorch G, Hartl H, Roth B, Kribs A, Gortner L, Schaible T, et al. Surfactant aerosol treatment of respiratory distress syndrome in spontaneously breathing premature infants. Pediatr Pulmonol. 1997;24:222–4.

  26. 26.

    Finer NN, Merritt TA, Bernstein G, Job L, Mazela J, Segal R. An open label, pilot study of Aerosurf® combined with nCPAP to prevent RDS in preterm neonates. J Aerosol Med Pulm Drug Deliv. 2010;23:303–9.

  27. 27.

    Minocchieri S, Berry CA, Pilow JJ, CureNeb Study Team. Nebulised surfactant to reduce severity of respiratory distress: a blinded, parallel, randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2018 Jul 26. pii: fetalneonatal-2018-315051. https://doi.org/10.1136/archdischild-2018-315051.

  28. 28.

    Ten centre trial of artificial surfactant (artificial lung expanding compound) in very premature babies. Ten Centre Study Group. Br Med J (Clin Res Ed). 1987;294:991–6.

  29. 29.

    Dambeanu JM, Parmigiani S, Marinescu B, Bevilacqua G. Use of surfactant for prevention of respiratory distress syndrome in newborn infants in spontaneous breathing. A randomized multicentre clinical pilot-study. Acta Biomed Ateneo Parm. 1997;68(Suppl 1):39–45.

  30. 30.

    Kattwinkel J, Robinson M, Bloom BT, Delmore P, Ferguson JE. Technique for intrapartum administration of surfactant without requirement for an endotracheal tube. J Perinatol. 2004;24:360–5.

  31. 31.

    Barbosa RF, Marcatto Jde O, Silva AC, Silva YP. ProSealTMlaryngeal mask airway for surfactant administration in the treatment of respiratory distress syndrome in a premature infant. Rev Bras Ter Intensiva. 2012;24:207–10.

  32. 32.

    Sadeghnia A, Tanhaei M, Mohammadizadeh M, Nemati M. A comparison of surfactant administration through i-gel and ET-tube in the treatment of respiratory distress syndrome in newborns weighing more than 2000 grams. Adv Biomed Res. 2014;3:160.

  33. 33.

    Pinheiro JM, Santana-Rivas Q, Pezzano C. Randomized trial of laryngeal mask airway versus endotracheal intubation for surfactant delivery. J Perinatol. 2016;36:196–201.

  34. 34.

    Attridge JT, Stewart C, Stukenborg GJ, Kattwinkel J. Administration of rescue surfactant by laryngeal mask airway: lessons from a pilot trial. Am J Perinatol. 2013;30:201–6.

  35. 35.

    Brimacombe J, Gandini D, Keller C, Parotto M, Doglioni N, Trevisanuto D. The laryngeal mask airway for administration of surfactant in two neonates with respiratory distress syndrome. Paediatr Anaesth. 2004;14:188–90.

  36. 36.

    Micaglio M, Zanardo V, Ori C, Parotto M, Doglioni N, Trevisanuto D, et al. ProSeal LMA for surfactant administration. Paediatr Anaesth. 2008;18:91–2.

  37. 37.

    Dargaville PA, Kamlin CO, De Paoli AG, Carlin JB, Orsini F, Soll RF, et al. The OPTIMISTA trial: evaluation of minimallyinvasive surfactant therapy in preterm infants 2528 weeks gestation. BMC Pediatr. 2014;14:213.

  38. 38.

    Rigo V, Lefebvre C, Broux I. Surfactant instillation in spontaneously breathing preterm infants: a systematic review and meta-analysis. Eur J Pediatr. 2016;175:1933–42.

  39. 39.

    Isayama T, Iwami H, Mcdonald S, Beyene J. Association of noninvasive ventilation strategies with mortality and bronchopulmonary dysplasia among preterm infants: a systematic review and meta-analysis. JAMA. 2016;316:611–24. https://doi.org/10.1001/jama.2016.10708.

  40. 40.

    Lau C, Chamberlain R, Sun S. Less invasive surfactant administration reduces the need for mechanical ventilation in preterm infants: a meta-analysis. Glob Pediatr Health. 2017;4:2333794X17696683. https://doi.org/10.1177/2333794X17696683.

  41. 41.

    Aldana-Aguirre JC, Pinto m, Featherstone R, Kumar M. Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2017;102:F17–23.

  42. 42.

    Niemarkt HJ, Kuypers E, Jellema R. Effects of less-invasive surfactant administration on oxygenation, pulmonary surfactant distribution, and lung compliance in spontaneously breathing preterm lambs. Pediatr Res. 2014;76:166–70. https://doi.org/10.1038/pr.2014.66.

  43. 43.

    Li X, Cheng T, GuanR, Liang H, Lu WN, Zhang JH, et al. Effects of different surfactant administrations on cerebral autoregulation in preterm infants with respiratory distress syndrome. J Huazhong Univ Sci Technol Med Sci. 2016;36:801–5.

  44. 44.

    Dargaville PA, Ali SKM, Jackson HD, Williams C, De Paoli AG. Impact of minimally invasive surfactant therapy in preterm infants at 29-32 weeks gestation. Neonatology. 2018;113:7–14. https://doi.org/10.1159/000480066.

  45. 45.

    Vannozzi I, Ciantelli M, Moscuzza F, Scaramuzzo RT, Panizza D, et al. Catheter and laryngeal mask endotracheal surfactant therapy: the CALMEST approach as a novel MIST technique. J Matern Fetal Neonatal Med. 2017;30:2375–7. https://doi.org/10.1080/14767058.2016.1248938.

  46. 46.

    van der Burg PS, de Jongh FH, Miedema M, Frerichs I, van Kaam AH. Effect of minimally invasive surfactant therapy on lung volume and ventilation in preterm infants. J Pediatr. 2016;170:67–72. https://doi.org/10.1016/j.jpeds.2015.11.035.

  47. 47.

    Dekker J, Lopriore E, Rijken M, Rijntjes-Jacobs E, Smits-Wintjens, Te Pas A. Sedation during minimal invasive surfactant therapy in preterm infants. Neonatology. 2016;109:308–13. https://doi.org/10.1159/000443823.

  48. 48.

    Rigo V, Debauche C, Maton P, Broux I, Van Laere D, et al. Rigid catheters reduced duration of less invasive surfactant therapy procedures in manikins. Acta Paediatr. 2017;106:1091–6. https://doi.org/10.1111/apa.13850.

  49. 49.

    Tieg N, Weitkämper A, Rothermel J, Bigge N, Lilienthal E, Rossler L, et al. Observational study on Less Invasive Surfactant Administration (LISA) in preterm infants <29 weeks--short and long-term outcomes. Z Geburtshilfe Neonatol. 2015;219:266–73. https://doi.org/10.1055/s-0035-1547295.

  50. 50.

    Porath M, Korp L, Wendrich D, Dlugay V, Roth B, Kribs A. Surfactant in spontaneous breathing with nCPAP: neurodevelopmental outcome at early school age of infants ≤ 27 weeks. Acta Paediatr. 2011;100:352–9. https://doi.org/10.1111/j.1651-2227.2010.02068.x.

  51. 51.

    Klotz D, Porcaro U, Fleck T, Fuchs H. European perspective on less invasive surfactant administration—a survey. Eur J Pediatr. 2017;176:147–54. https://doi.org/10.1007/s00431-016-2812-9.

  52. 52.

    Heiring C, Jonsson B, Andersson S, Bjorklund LJ. Survey shows large differences between the Nordic countries in the use of less invasive surfactant administration. Acta Paediatr. 2017;106:382–6. https://doi.org/10.1111/apa.13694.

  53. 53.

    Feltman D, Du H, Leuthner S. Survey of neonatologists’ attitudes toward limiting life-sustaining treatments in the neonatal intensive care unit. J Perinatol. 2012;32:886–92.

Download references

Acknowledgements

Special thanks to Dr. James Cummings for his comments and help with editing this article. We also thank Jithin John, DO student, for the help with data processing.

Funding

No funding has been received for this study.

Author information

Affiliations

  1. Cohen Children’s Medical Center, New Hyde Park, NY, USA

    • Dalibor Kurepa
    • , Shahana Perveen
    •  & Yisrael Lipener
  2. University of Texas Southwestern Medical Center, Dallas, TX, USA

    • Venkatakrishna Kakkilaya

Authors

  1. Search for Dalibor Kurepa in:

  2. Search for Shahana Perveen in:

  3. Search for Yisrael Lipener in:

  4. Search for Venkatakrishna Kakkilaya in:

Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Dalibor Kurepa.

About this article

Publication history

Received

Revised

Accepted

Published

Issue Date

DOI

https://doi.org/10.1038/s41372-018-0302-9