Download PDF
Am J Perinatol 2025; 42(08): 1043-1050
DOI: 10.1055/a-2453-6883
Original Article

A Survey of Minimally Invasive Surfactant Use in the United States

Natasha Ahn
1   Section of Neonatology, Department of Pediatrics, University of Chicago Medicine Comer Children's Hospital, Chicago, Illinois
,
Matthew Derrick
2   Department of Pediatrics, University of Chicago and Endeavor Health System, Evanston, Illinois
,
Walid Hussain 
1   Section of Neonatology, Department of Pediatrics, University of Chicago Medicine Comer Children's Hospital, Chicago, Illinois
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective

Minimally invasive surfactant therapy (MIST) has become the standard of care in delivering surfactant noninvasively in many parts of the world, particularly throughout Europe; however, centers in the United States have been slower to adopt it. The most recent assessment of the use of MIST in the United States was in 2018 by Kurepa et al. Considering the increasing evidence favoring MIST, this paper reassessed the current rate of utilization and aims to examine barriers to MIST implementation.

Study Design

A web-based survey was distributed to approximately 4,500 individuals in the American Academy of Pediatrics Section of Neonatal-Perinatal Medicine (AAP SoNPM) mailing list. The questions were aimed at addressing MIST usage in the United States, examining barriers for neonatology providers to implement MIST into their practice, and determining the use of sedation during the MIST procedure.

Results

Of the 381 respondents, 39% used MIST as part of their practice, which was an increase from 15% in 2018. The most prevalent barrier to implementation was the lack of procedural training. There was a large increase in the use of sedation for the procedure compared with 2018.

Conclusion

MIST use among AAP SoNPM respondents has more than doubled since 2018; InSurE (INtubation-SURfactant delivery Extubation) remains the most prevalent method of surfactant delivery in non-intubated patients. The list of different types of barriers and comments provided by respondents can be a resource for units planning to implement MIST.

Key Points

  • The usage of MIST in the United States.

  • What are the barriers to MIST implementation?

  • The usage of sedation during MIST procedure.

Keywords

MIST - surfactant - survey - implementation barriers


Publication History

Received: 16 September 2024

Accepted: 28 October 2024

Article published online:
25 November 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kalikkot Thekkeveedu R, Guaman MC, Shivanna B. Bronchopulmonary dysplasia: a review of pathogenesis and pathophysiology. Respir Med 2017; 132: 170-177
    Search in Google Scholar
  • 2 Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB. COIN Trial Investigators. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med 2008; 358 (07) 700-708
    Search in Google Scholar
  • 3 Finer NN, Carlo WA, Walsh MC. et al; SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010; 362 (21) 1970-1979
    Search in Google Scholar
  • 4 Papile L-A, Baley JE, Benitz W. et al; Committee on Fetus and Newborn, American Academy of Pediatrics. Respiratory support in preterm infants at birth. Pediatrics 2014; 133 (01) 171-174
    Search in Google Scholar
  • 5 Sweet DG, Carnielli VP, Greisen G. et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology 2023; 120 (01) 3-23
    Search in Google Scholar
  • 6 Bahadue FL, Soll R. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev 2012; 11 (11) CD001456
    Search in Google Scholar
  • 7 Verder H, Agertoft L, Albertsen P. et al. Surfactant treatment of newborn infants with respiratory distress syndrome primarily treated with nasal continuous positive air pressure. A pilot study [in Danish]. Ugeskr Laeger 1992; 154 (31) 2136-2139
    Search in Google Scholar
  • 8 Kribs A, Vierzig A, Hünseler C. et al. Early surfactant in spontaneously breathing with nCPAP in ELBW infants–a single centre four year experience. Acta Paediatr 2008; 97 (03) 293-298
    Search in Google Scholar
  • 9 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 (04) 364-369
    Search in Google Scholar
  • 10 Kanmaz HG, Erdeve O, Canpolat FE, Mutlu B, Dilmen U. Surfactant administration via thin catheter during spontaneous breathing: randomized controlled trial. Pediatrics 2013; 131 (02) e502-e509
    Search in Google Scholar
  • 11 Dargaville PA, Kamlin CO, De Paoli AG. et al. The OPTIMIST-A trial: evaluation of minimally-invasive surfactant therapy in preterm infants 25–28 weeks gestation. BMC Pediatr 2014; 14: 213
    Search in Google Scholar
  • 12 Abdel-Latif ME, Davis PG, Wheeler KI, De Paoli AG, Dargaville PA. Surfactant therapy via thin catheter in preterm infants with or at risk of respiratory distress syndrome. Cochrane Database Syst Rev 2021; 5 (05) CD011672
    Search in Google Scholar
  • 13 Sawyer T, Foglia EE, Ades A. et al; National Emergency Airway Registry for Neonates (NEAR4NEOS) investigators. Incidence, impact and indicators of difficult intubations in the neonatal intensive care unit: a report from the National Emergency Airway Registry for Neonates. Arch Dis Child Fetal Neonatal Ed 2019; 104 (05) F461-F466
    Search in Google Scholar
  • 14 Singh N, Sawyer T, Johnston LC. et al; National Emergency Airway Registry for Neonates (NEAR4NEOS). Impact of multiple intubation attempts on adverse tracheal intubation associated events in neonates: a report from the NEAR4NEOS. J Perinatol 2022; 42 (09) 1221-1227
    Search in Google Scholar
  • 15 Sweet DG, Carnielli V, Greisen G. et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2019 Update. Neonatology 2019; 115 (04) 432-450
    Search in Google Scholar
  • 16 Kurepa D, Perveen S, Lipener Y, Kakkilaya V. The use of less invasive surfactant administration (LISA) in the United States with review of the literature. J Perinatol 2019; 39 (03) 426-432
    Search in Google Scholar
  • 17 Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci 2022; 17 (01) 75
    Search in Google Scholar
  • 18 Escobar GJ, Puopolo KM, Wi S. et al. Stratification of risk of early-onset sepsis in newborns ≥ 34 weeks' gestation. Pediatrics 2014; 133 (01) 30-36
    Search in Google Scholar
  • 19 Klotz D, Porcaro U, Fleck T, Fuchs H. European perspective on less invasive surfactant administration-a survey. Eur J Pediatr 2017; 176 (02) 147-154
    Search in Google Scholar
  • 20 Brahmbhatt S, Read B, Da Silva O, Bhattacharya S. A survey of minimally invasive surfactant therapy in Canada. Can J Respir Ther 2022; 58: 122-126
    Search in Google Scholar
  • 21 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 (06) 611-624
    Search in Google Scholar
  • 22 Aldana-Aguirre JC, Pinto M, Featherstone RM, 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 (01) F17-F23
    Search in Google Scholar
  • 23 Ng EH, Shah V. Guidelines for surfactant replacement therapy in neonates. Paediatr Child Health 2021; 26 (01) 35-49
    Search in Google Scholar
  • 24 Dargaville PA, Kamlin COF, Orsini F. et al; OPTIMIST-A Trial Investigators. Effect of minimally invasive surfactant therapy vs sham treatment on death or bronchopulmonary dysplasia in preterm infants with respiratory distress syndrome: The OPTIMIST-A Randomized Clinical Trial. JAMA 2021; 326 (24) 2478-2487
    Search in Google Scholar
  • 25 Kribs A, Roll C, Göpel W. et al; NINSAPP Trial Investigators. Nonintubated surfactant application vs conventional therapy in extremely preterm infants: a randomized clinical trial. JAMA Pediatr 2015; 169 (08) 723-730
    Search in Google Scholar
  • 26 Härtel C, Herting E, Humberg A. et al; German Neonatal Network. Association of administration of surfactant using less invasive methods with outcomes in extremely preterm infants less than 27 weeks of gestation. JAMA Netw Open 2022; 5 (08) e2225810
    Search in Google Scholar
  • 27 Fernandez C, Boix H, Camba F, Comuñas JJ, Castillo F. Less invasive surfactant administration in spain: a survey regarding its practice, the target population, and premedication use. Am J Perinatol 2020; 37 (03) 277-280
    Search in Google Scholar
  • 28 Mehler K, Oberthuer A, Haertel C, Herting E, Roth B, Goepel W. German Neonatal Network (GNN). Use of analgesic and sedative drugs in VLBW infants in German NICUs from 2003–2010. Eur J Pediatr 2013; 172 (12) 1633-1639
    Search in Google Scholar
  • 29 Jeffreys E, Hunt K, Dassios T, Greenough A. UK survey of less invasive surfactant administration. Arch Dis Childhood Fetal Neonatal Ed 2019; 104 (05) F567
    Search in Google Scholar
  • 30 Heiring C, Jonsson B, Andersson S, Björklund LJ. Survey shows large differences between the Nordic countries in the use of less invasive surfactant administration. Acta Paediatr 2017; 106 (03) 382-386
    Search in Google Scholar
  • 31 Maiwald CA, Franz AR, Poets CF, Springer L. LISA-Survey-Team Germany. Less invasive surfactant administration in preterm infants in tertiary neonatal intensive care units in germany: a survey. Neonatology 2024; 1-10
    Search in Google Scholar
  • 32 Moschino L, Ramaswamy VV, Reiss IKM, Baraldi E, Roehr CC, Simons SHP. Sedation for less invasive surfactant administration in preterm infants: a systematic review and meta-analysis. Pediatr Res 2023; 93 (03) 471-491
    Search in Google Scholar