181 Less invasive surfactant administration, a single centre experience

Less Invasive Surfactant Administration (LISA) introduced to the Trust ~April 2017 No specific gestation cut-off Indicated in all babies with a persistent O2 requirement of >30%

Aim

overview of all patients receiving surfactant from July 2020 to July 2022 Comparison of babies receiving surfactant via LISA and those receiving via Endotracheal tube (ETTS)

Results

Total patients receiving surfactant by any means: 149 babies LISA = 93 ETTS = 56 Total babies receiving LISA = 93 Number requiring 2nd dose of surfactant = 14 Required intubation after LISA = 38 (total) 15/38 <24 hours after LISA 23/38 >24 hours after LISA LISA cohort – Outcome based on dose/kg (n=93)

Outcome

Overall survival 91% of babies receiving LISA survived to discharge 72% of babies receiving surfactant and ventilated survived to discharge Discussion (1) There is experience internationally for use of LISA >15y Locally experience spans 5 years LISA is safe and long term outcome is reported to be better for preterm infant morbidity and mortality Over the study period of 2 years, ~150 babies received surfactant, 2/3 of which was via LISA The earliest gestation was 24+1/40 who received LISA which is comparable to the group receiving surfactant via ETT. Weight is NOT a limiting factor, as LISA cohort was received by an infant weighing just 465g (compared to ETT surfactant at 525g). There were no ethnicity or gender bias between both groups In the 23, 24 and 25/40 infants more received surfactant via ETT From 26/40 onwards the majority had LISA At gestations of 38/40+ LISA was almost exclusively used LISA was administered by all grades of staff from Foundation YR2 doctors to consultants Nearly 1/5 of procedures carried out by junior level staff Just 5% were undertaken by consultant level staff ANNP team were responsible for ¼ of procedures and deliver majority of training 91% of babies receiving LISA survived to discharge 23% had a final diagnosis of CLD 13% went home on oxygen 77% of babies who were intubated for surfactant survived to discharge 58% had a final diagnosis of CLD 46% were discharged on home oxygen

Conclusion

LISA is safe and long term outcome with regards to mortality is better than for those intubated to administer surfactant With appropriate training even the most junior of colleagues can administer LISA Patients who receive LISA have significantly better long term outcome with regards to CLD and requiring home O2