Outcomes of Preterm Infants Receiving Surfactant Administration with LISA versus INSURE Methods: A Retrospective Cohort Study

Introduction: Endotracheal administration of an exogenous surfactant is a standard therapeutic approach in respiratory distress syndrome of preterm neonates. At the same time, the currently preferred respiration support methods involve nasal continuous positive airway pressure (nCPAP) or a noninvasive ventilation. Both methods allow reduction of the risk of the mechanical ventilation-associated lung injury. Hence, alternative surfactant administration methods are being used more and more often. Those methods allow limiting the mechanical ventilation to the time of surfactant administration and possibly a short time afterward only (INSURE, intubation–surfactant–extubation), or even skipping the intubation and administering the drug while the patient is breathing spontaneously (LISA).

Materials and Methods: We studied neonates treated in the neonatology department in 2014 to 2016, with gestational age of 24 to 37 weeks, requiring respiration support with nCPAP before administration of a surfactant were enrolled to the retrospective analysis. The surfactant was administered using the LISA or the INSURE methods. We compared the short- and long-term respiratory outcomes and the occurrence of prematurity-related complications in both the groups.

Results: A total of 180 neonates were enrolled. The surfactant was administered using the LISA in 107 infants and in 73 with the INSURE methods. No differences in demographics (mean body weight 1,530 vs 1,560 g; mean maturity 30.7 vs. 30.7 weeks of pregnancy for LISA vs. INSURE, respectively) was noted between the groups. The analysis demonstrated that neonates who received the surfactant using the INSURE method achieved reduction of respiratory distress earlier within initial 72 hours after administration of the surfactant, and required less advanced respiration support techniques (IMV, CPAP + NV, CPAP); the difference was statistically significant (p = 0.029). A trend for decreased incidence of complications, including pneumothorax and pulmonary hemorrhage, was also observed in that group. However, differences did not reach the level of statistical significance. Also limiting the analysis to the group of neonates born before the gestational age of 33 weeks, no statistically significant differences were noted, but the INSURE group still demonstrated a trend for more rapid improvement of respiration within initial 72 hours. The analysis of long-term respiratory outcomes (intubations, number of days on mechanical ventilation, number of days on nCPAP respiratory support, number of days of oxygen treatment, and incidence of BPD) did not reveal any significant differences between the groups.

Conclusion: In the present, retrospective analysis of a single-center experience with the LISA surfactant administration method, the INSURE method looks more favorable in terms of reduction of need for respiratory support within the initial 72 hours after the surfactant administration. No significant differences were observed in incidence and severity progression of BPD between the two groups.

Keywords: LISA, INSURE, surfactant, RDS

No conflict of interest has been declared by the author(s).