Observational Study on Less Invasive Surfactant Administration (LISA) in Preterm Infants<29 Weeks – Short and Long-term Outcomes

Abstract

Background: A recent trial has demonstrated short-term benefits of a new minimal invasive procedure of surfactant administration in spontaneously breathing preterm infants ≥26 weeks (less invasive surfactant administration, LISA).

Aim: To assess safety as well as short- and long-term outcomes of the LISA procedure in preterm infants between 23–28 weeks of gestation.

Study design: Preterm infants born between 23+0 and 28+6 weeks gestational age during 2 periods, 18 months before (Period 1, n=44) and 18 months after introduction of LISA (Period 2, n=53), were analyzed for neonatal outcomes. 52% of discharged infants were assessed for neurodevelopmental outcome at corrected age of 3 years.

Results: In Period 2, 66% of the preterm infants needing surfactant were treated by the new method of LISA. In this period, fewer patient had to be ventilated during the first 3 days of life (42 vs. 77%, p<0.0005) and overall (55 vs. 77%, p=0.02). The median duration of mechanical ventilation was 2 vs. 3 days (p=0.056). Survival without BPD was 68% in period 1 and 74% in period 2 (p=0.29). In period 2, fewer infants received antibiotics after the third day of life (43 vs. 66%, p=0.04), systemic glucocorticoids were less frequently used (7.5 vs. 23%, p=0.04), and more infants received doxapram (34 vs. 2.3%, p<0.0001). Mental Developmental Index (89 vs. 98, p=0.16) and Physical Developmental Index (83 vs. 91, p=0.03) at 3 years improved between the 2 periods.

Conclusion: Implementation of the LISA method on a neonatal ward was safe and feasible and was associated with less need for mechanical ventilation in infants >24 weeks. As our study was retrospective the observed trends for better pulmonary and neurocognitive outcomes should be interpreted with caution until results from randomized trials on the LISA procedure are available.

Zusammenfassung

Hintergrund: Kürzlich publizierte randomisierte Studie haben eine Verminderung einiger kurzfristiger Komplikationen durch eine neue weniger invasive Methode der Surfactantapplikation (LISA) bei Frühgeborenen < 29 Schwangerschaftswochen gezeigt.

Ziel: Wir analysierten die Sicherheit und die kurz-und langfristigen Auswirkungen nach Einführung dieser neuen Methode auf unserer Station.

Studiendesign: Die Neonataldaten von Frühgeborenen mit 23+0 bis 28+6 Gestationswochen, die vor (Periode 1, n=44) und nach Einführung der neuen Methode (Periode 2, n=53) behandelt wurden, wurden analysiert. 52% der entlassenen Kinder konnten im korrigierten Alter von 36 Monaten nachuntersucht werden.

Ergebnisse: In Periode 2 konnten 66% der Frühgeborenen, die Surfactant erhielten, mit der LISA-Methode behandelt werden, es mussten weniger Kinder beatmet werden (23 vs. 45%, p=0.02). Die Überlebensrate ohne BPD war 68% in Periode 1 und 75% in Periode 2 (p=0,29). In Periode 2 wurden weniger Kinder nach dem 3. Lebenstag antibiotisch behandelt (43 vs. 66%, p=0,04), weniger Kinder erhielten systemische Glucocorticoide (7,5 vs. 23%, p=0.04), aber häufiger Doxapram (34 vs. 2,3%, p<0,0001). Der mediane mentale Entwicklungsindex (MDI) stieg von 89 auf 98 (p=0,16), der mediane motorische Entwicklungsindex (PDI) von 83 auf 91 (p=0,03).

Zusammenfassung: Die Einführung der LISA-Methode war sicher und gut umzusetzen. Die Trends zu einer verbesserten pulmonalen und neurokognitiven Entwicklung sollten wegen des retrospektiven Designs unserer Studie mit Vorsicht interpretiert werden bis Nachuntersuchungs-Daten randomisierter Studien zu LISA publiziert werden.

Key words

preterm birth - surfactant - follow-up

Schlüsselwörter

Frühgeburt - Surfactant - neurologische Entwicklung

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