Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants

2015 ◽  
Vol 104 (3) ◽  
pp. 241-246 ◽  
Author(s):  
Wolfgang Göpel ◽  
Angela Kribs ◽  
Christoph Härtel ◽  
Stefan Avenarius ◽  
Norbert Teig ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Less Invasive ◽  
Surfactant Administration ◽  
Spontaneously Breathing

scholarly journals The Miracles of Surfactant: Less Invasive Surfactant Administration, Nebulization, and Carrier of Topical Drugs

Neonatology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Christoph Härtel ◽  
Kirsten Glaser ◽  
Christian P. Speer
Keyword(s):  
Replacement Therapy ◽  
Preterm Infants ◽  
Invasive Mechanical Ventilation ◽  
Lung Surfactant ◽  
Standard Of Care ◽  
Less Invasive ◽  
Surfactant Replacement Therapy ◽  
Surfactant Administration ◽  
Invasive Techniques ◽  
Spontaneously Breathing

Surfactant replacement therapy (SRT) has long become the standard of care in the treatment of neonatal respiratory distress syndrome (RDS), significantly decreasing acute pulmonary morbidity and mortality in preterm infants. For decades, this beneficial replacement therapy has been administered via endotracheal tube. Despite significantly improving the outcome of RDS, however, the burden of bronchopulmonary dysplasia remains, in particular, in very immature preterm infants. Acknowledging the direct relationship between exposure to and duration of invasive mechanical ventilation and chronic lung disease, the latter has been gradually replaced by noninvasive ventilation strategies in neonatal RDS. This replacement is strongly related to the demand for similarly noninvasive modes of surfactant administration. Alternative techniques in spontaneously breathing infants have evolved, including less invasive techniques using thin catheters (less invasive surfactant administration and minimally invasive surfactant treatment) as well as nebulization of surfactant, although the latter is not ready for clinical application yet. In addition, given their therapeutic delivery to the lungs and subsequent alveolar distribution, surfactant preparations represent an attractive vehicle for pulmonary deposition of drugs in preterm infants. Further improvement of SRT and expansion of the field of application of lung surfactant may hold additional benefits, especially in the treatment of the most immature preterm infants.

The effect of less invasive surfactant administration on cerebral oxygenation in preterm infants

2019 ◽  
Vol 109 (2) ◽  
pp. 291-299 ◽  
Author(s):  
Kathrin Hanke ◽  
Tanja K. Rausch ◽  
Pia Paul ◽  
Isabel Hellwig ◽  
Christina Krämer ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Cerebral Oxygenation ◽  
Less Invasive ◽  
Surfactant Administration

Propofol for sedation during less invasive surfactant administration in preterm infants

2017 ◽  
Vol 102 (5) ◽  
pp. F465-F465 ◽  
Author(s):  
Claire Sophie Descamps ◽  
Marie Chevallier ◽  
Anne Ego ◽  
Isabelle Pin ◽  
Chloé Epiard ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Less Invasive ◽  
Surfactant Administration

scholarly journals Improved Less Invasive Surfactant Administration Success in Preterm Infants after Procedure Standardization

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1145
Author(s):  
Björn Liebers ◽  
Chinedu Ulrich Ebenebe ◽  
Monika Wolf ◽  
Martin Ernst Blohm ◽  
Eik Vettorazzi ◽  
...  
Keyword(s):  
Success Rate ◽  
Preterm Infants ◽  
Patient Characteristics ◽  
Team Training ◽  
Adverse Outcomes ◽  
Less Invasive ◽  
Characteristics Method ◽  
Perinatal Center ◽  
The Mean ◽  
Surfactant Administration

Less invasive surfactant administration (LISA) has been introduced at our tertiary Level IV perinatal center since 2016 with an unsatisfactory success rate, which we attributed to an inconsistent, non-standardized approach and ambiguous patient inclusion criteria. This study aimed to improve the LISA success rate to at least 75% within 12 months by implementing a highly standardized LISA approach combined with team training. The Plan Do Study Act method of quality improvement was used for this initiative. Baseline assessment included a review of patient medical records 12 months before the intervention regarding patient characteristics, method success rate, respiratory, and adverse outcomes. A multi-professional team developed a standardized LISA approach and a training program including an educational film, checklists, pocket cards, and team briefings. Twenty-one preterm infants received LISA before and 24 after the intervention. The mean LISA success rate improved from 62% before the intervention to 92% (p = 0.029) after the intervention. Implementing a highly standardized LISA approach and multi-professional team training significantly improved the methods’ success rate.

scholarly journals Less Invasive Surfactant Administration in Very Prematurely Born Infants

2021 ◽  
Vol 11 (03) ◽  
pp. e119-e122
Author(s):  
Sandeep Shetty ◽  
Helen Egan ◽  
Peter Cornuaud ◽  
Anay Kulkarni ◽  
Donovan Duffy ◽  
...  
Keyword(s):  
Noninvasive Ventilation ◽  
Length Of Hospital Stay ◽  
Neonatal Unit ◽  
Invasive Ventilation ◽  
Less Invasive ◽  
Historical Comparison ◽  
Preterm Babies ◽  
Surfactant Administration ◽  
Spontaneously Breathing ◽  
Prematurely Born Infants

Abstract Background Less invasive surfactant administration (LISA) is the preferred mode of surfactant administration for spontaneously breathing preterm babies supported by noninvasive ventilation (NIV). Objective The aim of this study was to determine whether LISA on the neonatal unit or in the delivery suite was associated with reduced rates of bronchopulmonary dysplasia (BPD) or the need for intubation, or lower durations of invasive ventilation and length of hospital stay (LOS). Methods A historical comparison was undertaken. Each “LISA” infant was matched with two infants (controls) who did not receive LISA. Results The 25 LISA infants had similar gestational ages and birth weights to the 50 controls (28 [25.6–31.7] weeks vs. 28.5 [25.4–31.9] weeks, p = 0.732; 1,120 (580–1,810) g vs. 1,070 [540–1,869] g, p = 0.928), respectively. LISA infants had lower requirement for intubation (52 vs. 90%, p < 0.001), shorter duration of invasive ventilation (median 1 [0–35] days vs. 6 [0–62] days p = 0.001) and a lower incidence of BPD (36 vs. 64%, p = 0.022). There were no significant differences in duration of NIV (median 26 [3–225] vs. 23 [2–85] days, p = 0.831) or the total LOS (median 76 [24–259] vs. 85 [27–221], p = 0.238). Conclusion LISA on the neonatal unit or the delivery suite was associated with a lower BPD incidence, need for intubation, and duration of invasive ventilation.

scholarly journals Less-Invasive Surfactant Administration for Neonatal Respiratory Distress Syndrome: A Consensus Guideline

Neonatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Peter Reynolds ◽  
Porus Bustani ◽  
Colm Darby ◽  
Jose Ramon Fernandez Alvarez ◽  
Grenville Fox ◽  
...  
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Distress Syndrome ◽  
Successful Implementation ◽  
Sufficient Information ◽  
Online Questionnaire ◽  
Less Invasive ◽  
Risk Of Death ◽  
Surfactant Administration

<b><i>Introduction:</i></b> Less-invasive surfactant administration (LISA) is a method of surfactant delivery to preterm infants for treating respiratory distress syndrome (RDS), which can reduce the composite risk of death or bronchopulmonary dysplasia and the time on mechanical ventilation. <b><i>Methods:</i></b> A systematic literature search of studies published up to April 2021 on minimally invasive catheter surfactant delivery in preterm infants with RDS was conducted. Based on these studies, with parental feedback sought via an online questionnaire, 9 UK-based specialists in neonatal respiratory disease developed their consensus for implementing LISA. Recommendations were developed following a modified, iterative Delphi process using a questionnaire employing a 9-point Likert scale and an a priori level of agreement/disagreement. <b><i>Results:</i></b> Successful implementation of LISA can be achieved by training the multidisciplinary team and following locally agreed guidance. From the time of the decision to administer surfactant, LISA should take &#x3c;30 min. The comfort of the baby and requirements to maintain non-invasive respiratory support are important. While many infants can be managed without requiring additional sedation/analgesia, fentanyl along with atropine may be considered. Parents should be provided with sufficient information about medication side effects and involved in treatment discussions. <b><i>Conclusion:</i></b> LISA has the potential to improve outcomes for preterm infants with RDS and can be introduced as a safe and effective part of UK-based neonatal care with appropriate training.

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