Less Invasive Surfactant Administration via Thin Catheter in Late Preterm Infants With Respiratory Distress Syndrome

Abstract Background: The use of less invasive surfactant administration (LISA) has been increasingly investigated, since neonatal respiratory distress syndrome (RDS) due to surfactant deficiency is associated with high morbidity and mortality in preterm infants. However, this technique has been barely studied in late preterm newborns with RDS. In the present study, we analyzed the use of LISA using a thin catheter in late preterm infants with RDS who required noninvasive ventilation (NIV).Methods: A retrospective study was conducted on late preterm infants admitted to the Neonatal Intensive Care Unit –­ Virgen de la Arrixaca University Hospital in Murcia (Spain), between June 2017­­­ and March 2020. Maternal and prenatal data, as well as safety and efficacy variables related to the technique were collected. Statistical analyses were performed using SPSS version 20.0.Results: A total of 20 patients were included. The mean gestational age was 35 (341/7-366/7) weeks. There were 12 males (60.0%) and 8 females (40.0%). Seven infants (35.0%) received prenatal corticosteroids for fetal lung maturation. Mothers had a mean age of 31.0 (16-40) years and only one had a medical condition (HELLP syndrome). The more frequent type of delivery was C-section (75.0%). Ten newborns (50.0%) required resuscitation to breathe with nCPAP or nIPPV, with no signs of acute fetal distress. Before LISA, mean pCO2, pH and FiO2 values were 53 (40-81) mmHg, 7.28 (7.19-7.48), and 0.41 (0.3-0.6), respectively. Thirteen patients (65.0%) were treated with nCPAP and seven (35.0%) with nIPPV. Premedications administered were caffeine (50.0%) and ketamine/morphine sedation (20.0%). During LISA, oxygen saturation decreased in fifteen patients (75.0%). Redosing was needed in two infants (10.0%). Response was favorable, with a rapid and sustained reduction in FiO2 (FiO2 of 0.21 in 85.0% of cases) and NIV mean time of 70 hours. Patients with final diagnosis of RDS (90.0%) did not required invasive mechanical ventilation (IMV). No severe comorbidities and no deaths occurred.Conclusions: LISA procedure was a safe and effective method of surfactant delivery in late premature neonates with RDS, improving respiratory outcomes with no need for IMV. These findings add to the knowledge of respiratory management of late preterm infants.