Outcomes following less-invasive-surfactant-administration in the delivery-room
Fahad M. S. Arattu Thodika, Hemant Ambulkar, Emma Williams, Ravindra Bhat, Theodore Dassios, Anne Greenough
Abstract
Less invasive surfactant administration (LISA) on the neonatal unit reduces the need for mechanical ventilation and bronchopulmonary dysplasia (BPD). To assess the immediate and longer-term efficacy of LISA to prematurely born infants in the delivery-room. A case control study with inborn historical controls matched for gestational age, birthweight and gender to each LISA infant. Infants born between 26+0 weeks and 34+6 weeks of gestational age. Respiratory function monitoring before and after LISA and need for mechanical ventilation within 72 h of birth. Ninety-nine infants, median gestational age of 32+4(range:27+0–34+6) weeks, were prospectively recruited. The respiratory rate and inspired oxygen (FiO2) decreased two minutes after LISA and there was a reduction in the FiO2 requirement at two hours post birth. Compared to historical controls, LISA administration was associated with a reduction in the need for mechanical ventilation within 72 h after birth (20.2% versus 56.6% p < 0.001) the incidence of moderate to severe BPD (8.2% versus 20.2%, p = 0.02) and the median costs of neonatal intensive care stay (£1218 versus £2436, p = 0.03) and total neonatal unit stay (£12,888 versus £17,240, p = 0.04). A high FiO2 in the delivery-room pre-LISA (median 0.75 versus 0.60, p = 0.02) was associated with LISA failure, that is mechanical ventilation within 72 h of birth. LISA to prematurely born infants in the delivery-room was associated with reductions in the need for mechanical ventilation and costs of care, but was less successful in those with initial, more severe respiratory disease.