Late Breaking Abstract - Less invasive surfactant administration (LISA) to preterm infants on high flow nasal cannula (nHFT)

Abstract

Introduction: In Neonates with RDS to avoid intubation and Mechanical Ventilation (MV), LISA was developed. Systematic reviews report that LISA compared with the standard surfactant replacement was associated with a lower rate of death and BPD at 36 weeks, risk of BPD, need for MV within 72 hours of birth, or MV during the hospital stay.

Objective: To audit the current local practice of LISA and its effectiveness when nHFT was predominantly used.

To assess the efficacy of a current protocol of providing a modified dosing regimen of conventional pre-intubation medication before giving LISA/ MIST.

Methods: Retrospective audit of nHFT-LISA in two Thames Valley network neonatal units.

The local LISA protocol recommended 1/3rd dose of Fentanyl (0.67mcg/kg) and atropine 20mcg/kg as premedication. The premedications were omitted only on consultant decision. Data was collected between Oct. 2019 - Sept. 2020.

Results: 46 infants received surfactant by LISA. Of these, 26 neonates did not receive premedication, the remaining 20 infants did. Comparison between the 2 groups are as shown in the table attached.

Conclusions: We observed reduced rates of MV in the first 72 hours following nHFT-LISA. nHFT-LISA was feasible and well tolerated without use of premedication.

The use of premedication should be reserved for babies in whom procedural difficulties are expected, this will depend on baby’s tone, size or gestation.

Based on our very positive experience with nHFT-LISA in a non-tertiary unit, we believe that there would be scope for use of LISA in level 2 units which will need more training of the staff there. It might help reduce transfers to higher level care centres for invasive respiratory  therapies.