PC1079: Novel Application of Neonatal Point-of-care Ultrasound: Ultrasound-guided Less Invasive Surfactant Administration

Background: Point-of-care ultrasound (POCUS) has become a very useful tool in guiding bedside clinical management. This study aims to describe a novel and innovative application of neonatal point-of-care ultrasound (POCUS): Ultrasound-guided Less Invasive Surfactant Administration (LISA).

Methods: This is a single-center, prospective observational study conducted in a level III NICU. In our unit, LISA is performed routinely in newborns on noninvasive respiratory support needing surfactant replacement therapy. A 16 G 5.25 BD Angiocath is adapted to deliver the surfactant. The catheter insertion was performed as per standard hospital protocol. As part of the study protocol, ultrasonography was used to identify and confirm catheter position inside the trachea, along with video laryngoscopy (C-MAC) in all cases to ensure that the catheter is passing through the vocal cords. Ultrasonography was performed with the linear transducer (GE LOGIQ e) positioned transversely over the suprasternal notch. The trachea can be identified in the midline position as a hyperechoic air-mucosa interface with reverberation artifacts. A palpable anatomic landmark allows for a simpler, more feasible, and reproducible technique while ensuring, based on anatomy, the visualization of the catheter in the correct position (midline, inside the trachea, in between the vocal cords and above the carina).

Results: We studied 12 patients with 13 surfactant administrations (Table 1). The mean gestational age was 32+1/7 weeks, with a mean birth weight of 1765 grams. The catheter was detected in all patients by using point-of-care ultrasonography. Visualization of the catheter and the surfactant instillation were obtained in all cases (Figure 1). Although the small size of the patients made the procedure more challenging, interfering in some cases with the person inserting the laryngoscope, rotation of the probe indicator allows the insertion of the laryngoscope without changing the location of the trachea.

Conclusion: This is the first description of “ultrasound-guided less invasive surfactant administration" to the best of our knowledge. It is a simple, feasible, and reproducible technique that allows for catheter confirmation inside the trachea when video laryngoscopy is unavailable.