Abstract
Introduction: 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. Methods: 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. Results: 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 <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. Conclusion: 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.
References
1.
Delara
M
, Chauhan
BF
, Le
ML
, Abou-Setta
AM
, Zarychanski
R
, ’tJong
GW
. Efficacy and safety of pulmonary application of corticosteroids in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis
. Arch Dis Child Fetal Neonatal Ed
. 2019
;104
(2
):F137
–44
. .2.
National Heart, Lung and Blood Institute
. Respiratory distress syndrome
. Available from: https://www.nhlbi.nih.gov/health-topics/respiratory-distress-syndrome Accessed 2021 Jun 28.3.
Reuter
S
, Moser
C
, Baack
M
. Respiratory distress in the newborn
. Pediatr Rev
. 2014
;35
(10
):417
–28
; quiz 29. .4.
Sweet
DG
, Carnielli
V
, Greisen
G
, Hallman
M
, Ozek
E
, Te Pas
A
, European consensus guidelines on the management of respiratory distress syndrome–2019 update
. Neonatology
. 2019
;115
(4
):432
–50
. .5.
Dargaville
PA
. Cpap, surfactant, or both for the preterm infant: resolving the dilemma
. JAMA Pediatr
. 2015
;169
(8
):715
–7
. .6.
Dargaville
PA
, Aiyappan
A
, De Paoli
AG
, Kuschel
CA
, Kamlin
CO
, Carlin
JB
, Minimally-invasive surfactant therapy in preterm infants on continuous positive airway pressure
. Arch Dis Child Fetal Neonatal Ed
. 2013
;98
(2
):F122
–6
. .7.
Kribs
A
. How best to administer surfactant to VLBW infants?
Arch Dis Child Fetal Neonatal Ed
. 2011
;96
(4
):F238
–40
. .8.
Kribs
A
, Roll
C
, Göpel
W
, Wieg
C
, Groneck
P
, Laux
R
, Nonintubated surfactant application vs conventional therapy in extremely preterm infants: a randomized clinical trial
. JAMA Pediatr
. 2015
;169
(8
):723
–30
. .9.
Vento
M
, Bohlin
K
, Herting
E
, Roehr
CC
, Dargaville
PA
. Surfactant administration via thin catheter: a practical guide
. Neonatology
. 2019
;116
(3
):211
–26
. .10.
Verder
H
, Robertson
B
, Greisen
G
, Ebbesen
F
, Albertsen
P
, Lundstrøm
K
, Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. Danish-Swedish multicenter study group
. N Engl J Med
. 1994
;331
(16
):1051
–5
. .11.
Gopel
W
, Kribs
A
, Ziegler
A
, Laux
R
, Hoehn
T
, Wieg
C
, Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial
. Lancet
. 2011
;378
(9803
):1627
–34
.12.
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
(1
):F17
–23
. .13.
Jena
SR
, Bains
HS
, Pandita
A
, Verma
A
, Gupta
V
, Kallem
VR
, Surfactant therapy in premature babies: sure or insure
. Pediatr Pulmonol
. 2019
;54
(11
):1747
–52
. .14.
Wang
XA
, Chen
LJ
, Chen
SM
, Su
PH
, Chen
JY
. Minimally invasive surfactant therapy versus intubation for surfactant administration in very low birth weight infants with respiratory distress syndrome
. Pediatr Neonatol
. 2020
;61
(2
):210
–5
. .15.
Panza
R
, Laforgia
N
, Bellos
I
, Pandita
A
. Systematic review found that using thin catheters to deliver surfactant to preterm neonates was associated with reduced bronchopulmonary dysplasia and mechanical ventilation
. Acta Paediatr
. 2020
;109
:2219
–25
. .16.
Herting
E
, Kribs
A
, Härtel
C
, von der Wense
A
, Weller
U
, Hoehn
T
, Two-year outcome data suggest that less invasive surfactant administration (LISA) is safe. Results from the follow-up of the randomized controlled AMV (avoid mechanical ventilation) study
. Eur J Pediatr
. 2020
;179
(8
):1309
–13
. .17.
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
(3
):277
–80
. .18.
Herting
E
, Härtel
C
, Göpel
W
. Less invasive surfactant administration: best practices and unanswered questions
. Curr Opin Pediatr
. 2020
;32
(2
):228
–34
. .19.
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
(3
):382
–6
. .20.
Klotz
D
, Porcaro
U
, Fleck
T
, Fuchs
H
. European perspective on less invasive surfactant administration-a survey
. Eur J Pediatr
. 2017
;176
(2
):147
–54
. .21.
Jeffreys
E
, Hunt
K
, Dassios
T
, Greenough
A
. UK survey of less invasive surfactant administration
. Arch Dis Child Fetal Neonatal Ed
. 2019
;104
(5
):F567
. .22.
Banerjee
S
, Fernandez
R
, Fox
GF
, Goss
KCW
, Mactier
H
, Reynolds
P
, Surfactant replacement therapy for respiratory distress syndrome in preterm infants: United Kingdom national consensus
. Pediatr Res
. 2019
;86
(1
):12
–4
. .23.
Hasson
F
, Keeney
S
, McKenna
H
. Research guidelines for the Delphi survey technique
. J Adv Nurs
. 2000
;32
(4
):1008
–15
. .24.
Sawyer
T
, White
M
, Zaveri
P
, Chang
T
, Ades
A
, French
H
, Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine
. Acad Med
. 2015
;90
(8
):1025
–33
. .25.
Fabbri
L
, Klebermass-Schrehof
K
, Aguar
M
, Harrison
C
, Gulczyńska
E
, Santoro
D
, Five-country manikin study found that neonatologists preferred using the LISAcath rather than the Angiocath for less invasive surfactant administration
. Acta Paediatr
. 2018
;107
(5
):780
–3
. .26.
de Kort
E
, Kusters
S
, Niemarkt
H
, van Pul
C
, Reiss
I
, Simons
S
, Quality assessment and response to less invasive surfactant administration (LISA) without sedation
. Pediatr Res
. 2020
;87
(1
):125
–30
. .27.
Ho
LP
, Ho
SS
, Leung
DY
, So
WK
, Chan
CW
. A feasibility and efficacy randomised controlled trial of swaddling for controlling procedural pain in preterm infants
. J Clin Nurs
. 2016
;25
(3–4
):472
–82
. .28.
McPherson
C
, Grunau
RE
. Neonatal pain control and neurologic effects of anesthetics and sedatives in preterm infants
. Clin Perinatol
. 2014
;41
(1
):209
–27
. .29.
Shah
PS
, Herbozo
C
, Aliwalas
LL
, Shah
VS
. Breastfeeding or breast milk for procedural pain in neonates
. Cochrane Database Syst Rev
. 2012
;12
:Cd004950
. .30.
Stevens
B
, Yamada
J
, Ohlsson
A
, Haliburton
S
, Shorkey
A
. Sucrose for analgesia in newborn infants undergoing painful procedures
. Cochrane Database Syst Rev
. 2016
;7
:Cd001069
. .31.
Roberts
CT
, Halibullah
I
, Bhatia
R
, Green
EA
, Kamlin
COF
, Davis
PG
, Outcomes after introduction of minimally invasive surfactant therapy in two Australian tertiary neonatal units
. J Pediatr
. 2021
;229
:141
–6
. .32.
Olivier
F
, Nadeau
S
, Bélanger
S
, Julien
AS
, Massé
E
, Ali
N
, Efficacy of minimally invasive surfactant therapy in moderate and late preterm infants: a multicentre randomized control trial
. Paediatr Child Health
. 2017
;22
(3
):120
–4
. .33.
Dekker
J
, Lopriore
E
, Rijken
M
, Rijntjes-Jacobs
E
, Smits-Wintjens
V
, Te Pas
A
. Sedation during minimal invasive surfactant therapy in preterm infants
. Neonatology
. 2016
;109
(4
):308
–13
. .34.
Dekker
J
, Lopriore
E
, van Zanten
HA
, Tan
RNGB
, Hooper
SB
, Te Pas
AB
. Sedation during minimal invasive surfactant therapy: a randomised controlled trial
. Arch Dis Child Fetal Neonatal Ed
. 2019
;104
(4
):F378
–83
. .35.
Bosnjak
ZJ
, Logan
S
, Liu
Y
, Bai
X
. Recent insights into molecular mechanisms of propofol-induced developmental neurotoxicity: implications for the protective strategies
. Anesth Analg
. 2016
;123
(5
):1286
–96
. .36.
Welzing
L
, Kribs
A
, Eifinger
F
, Huenseler
C
, Oberthuer
A
, Roth
B
. Propofol as an induction agent for endotracheal intubation can cause significant arterial hypotension in preterm neonates
. Paediatr Anaesth
. 2010
;20
(7
):605
–11
. .37.
Kumar
P
, Denson
SE
, Mancuso
TJ
. Premedication for nonemergency endotracheal intubation in the neonate
. Pediatrics
. 2010
;125
(3
):608
–15
. .38.
British Association of Perinatal Medicine. Enhanced shared decision making in neonatal care - a framework for practice. 2019.
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2021
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