PC1080: Least Invasive Surfactant Administration (LISA): Improving Reliability for a Safe and New Standard of Care

Purpose/Objectives: Surfactant administration by endotracheal intubation is an invasive and traumatic technique that requires sedation and mechanical ventilation, which may increase the risk of bronchopulmonary dysplasia (BPD). LISA has not gained widespread acceptance as catheter placement cannot be confirmed. People have tried to use even Ultrasound to confirm the tube. Our method of using End Tidal (ET) CO2 resulted in improved outcomes in a large community NICU.

Design/Methods: A retrospective analysis of patients requiring surfactant and not intubated before admission into the NICU. LISA was administered using a 16-gauge, 5.25-inch angiocath, with ETCO2 confirming placement. ETCO2 changes color when given enough time usually 10-15 seconds. Surfactant was given by syringe over 5 minutes while non-invasive ventilation was continued along with oral sucrose and pacifier.

Results: 40 patients were given surfactant by LISA in 2021. The average gestational age was 30 weeks (range 23-41 weeks) and the birth weight (BW) was 1652 grams (gm) (range 565 -3615 gm). 20 patients were < 1500 gm, a subset of 12 were under 1000 gm. One baby with severe congenital anomalies was excluded from final analysis. All babies with LISA remained on non-invasive ventilation at 24 hours post surfactant administration. There were no acute complications. A total of 5 patients were intubated, 1 patient within 48 hours and the rest between 7 and 15 days of age. Overall, there was 1 case of pneumothorax.

In the < 1500-gram group, BPD occurred in 2 patients. Patent Ductus Arteriosus (PDA) needing treatment 1, Early onset sepsis (EOS) 0, necrotizing Enterocolitis (NEC) 1, severe Intraventricular hemorrhage (IVH) 1, Retinopathy of prematurity (ROP) surgery 0, mortality 1 (from late NEC after 2 months age), Pneumothorax 0, Ventilator associated Pneumonia 0.
Historical Vermont Oxford Network (VON) control for our medical center for the year 2020 (about 100 babies each year) and mean VON scores for 2020 are in figure 1 for comparison. Our overall baby monitor scores are 99%ile (figure 2) for context setting.

Conclusion/Discussion: Our quality improvement project demonstrates that LISA is a safe and reliable method of surfactant delivery. It results in improved neonatal outcomes and a drastic decrease in the incidence of BPD. In addition, we observed that patients can remain on the same mode of non-invasive ventilation post LISA. Furthermore, LISA utilized as a standard of care has the potential to decrease trauma due to endotracheal intubation, need for mechanical ventilation, and BPD.