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Evaluation of a respiratory care protocol including less invasive surfactant administration in preterm infants

Pediatric Research (2023)Cite this article

Abstract

Background

Respiratory care protocol including less invasive śsurfactant administration (LISA) in ≤29 weeks’ gestational age (GA) infants introduced in October 2018.

Methods

Retrospective study of infants admitted on continuous positive airway pressure (CPAP) October 2018 to December 2021. Maternal and neonatal variables were compared between infants managed on CPAP with and without LISA. Infants who received LISA and subsequently required mechanical ventilation (MV) within 72 h of life (HOL) [LISA failure (LF)] were compared with those who required no MV [LISA success (LS)].

Results

249 infants were admitted on CPAP, 5 were intubated prior to LISA, 143 required LISA and 101 remained on CPAP without surfactant. Of those receiving LISA, 108 were LS and 35 were LF. Compared to LS, LF infants were of lower GA and birth weight, required higher fractional inspired oxygen (FiO2), and CPAP level at birth, admission, one HOL, and an hour after LISA. Moreover, LF infants had higher mortality and morbidity. Together GA ≤ 25 weeks’ and FiO2 ≥ 0.3 an hour after LISA best predicted LF.

Conclusions

Over 80% of infants admitted on CPAP avoided MV within 72 HOL. Early predictors of LF provide targets for future interventions to decrease need for MV in preterm infants.

Impact

  • Less invasive surfactant administration (LISA) decreases the need for mechanical ventilation (MV) and improves outcomes. However, some infants require MV within 72 h of life (HOL) despite LISA (LISA failure).

  • Over 80% of ≤29 weeks’ gestational age (GA) infants can be successfully managed on CPAP with or without surfactant in the first 72 HOL.

  • A combination of factors including ≤25 weeks’ GA and fraction of inspired oxygen ≥0.3 an hour after LISA predict LISA failure.

  • Evaluation of a noninvasive respiratory support strategy including LISA provides targets for intervention to decrease need for MV in preterm infants.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Dr. Kakkilaya acknowledges the support from Parkland Community Health Plan.

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Authors and Affiliations

  1. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Christina S. Chan, Melody Chiu, Swathi Ariyapadi, Patti Burchfield, Kathryn Mazioniene, Mambarambath A. Jaleel, Myra H. Wyckoff, Vishal S. Kapadia & Venkatakrishna Kakkilaya

  2. Parkland Health and Hospital System, Dallas, TX, USA

    L. Steven Brown, Valerie Simcik & Kristi Garcia

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  1. Christina S. Chan
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Contributions

C.S.C. provided substantial contributions to drafting and revising the article for important intellectual content. S.A. provided substantial contributions to the acquisition of data. M.C. provided substantial contributions to the acquisition of data. L.S.B. provided substantial contributions to the analysis and interpretation of data through statistical support. P.B. provided substantial contributions to the acquisition of data. V.S. provided substantial contributions to the acquisition of data. K.G. provided substantial contributions to the acquisition of data. K.M. provided substantial contributions to the acquisition of data. M.A.J. provided substantial contributions to conception and design. M.H.W. provided substantial contributions to conception and design. V.S.K. provided substantial contributions to conception and design. V.K. provided substantial contributions to conception, design, data analysis and interpretation, drafting and revising of the article. All authors gave final approval of the version to be published.

Corresponding author

Correspondence to Venkatakrishna Kakkilaya.

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Competing interests

C.S.C. has no interests to declare. M.C. has no interests to declare. S.A. has no interests to declare. L.S.B. has no interests to declare. P.B. has no interests to declare. V.S. has no interests to declare. K.G. has no interests to declare. K.M. has no interests to declare. M.A.J. has no interests to declare. M.H.W. has no interests to declare. V.S.K. has no interests to declare. He acknowledges support by RO1HD104970-01 grant from the NIH. V.K. has received grant support from Chiesi Pharmaceuticals and SPARK Biomedical, Inc, USA. There is no conflict of interest relevant to this article with any of the entities.

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Chan, C.S., Chiu, M., Ariyapadi, S. et al. Evaluation of a respiratory care protocol including less invasive surfactant administration in preterm infants. Pediatr Res (2023). https://doi.org/10.1038/s41390-023-02963-x

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