Less Invasive Surfactant Administration in Preterm Neonates: A Single Centre Experience at a Tertiary Care Teaching Hospital

Abstract

Background Less Invasive Surfactant Administration (LISA) minimizes the need for invasive ventilation. As a result, it might improve survival rates in preterm newborns with respiratory distress syndrome (RDS), reducing long-term complications. This study explored the efficacy and potential benefits of the LISA in preterm newborns and its effect on short-term morbidity and mortality. Methods In this prospective observational study, 104 eligible preterm newborns <35 weeks of gestational age were admitted to NICU from August 2020 to July 2021at a tertiary care teaching institute in central India with RDS were given surfactant using 5F feeding tube without intubation while spontaneously breathing on NCPAP. Regarding respiratory parameters, invasive ventilation in the first 72 hours of age, mean duration of both invasive ventilation and NCPAP, mean duration of oxygen requirement, complications, and neonatal outcomes were assessed. Results The mean duration of the NCPAP requirement and the mean total duration of the oxygen requirement were 41.77 hours and 81.3 hours, respectively. Twenty-seven neonates (25.96%) required invasive ventilation within 72 hours of age. Fourteen neonates (13.46%) required second dose of surfactant. Total mortality till NICU stay was 30.76% (n = 32). Incidences of surfactant reflux to the esophagus, desaturation during the intervention procedure, and procedure complications (pulmonary hemorrhage, pneumothorax) were also less during the LISA method. Conclusion LISA is an alternative, safe, and feasible method for surfactant delivery in spontaneously breathing preterm neonates on NCPAP. Therefore, adopting this procedure in a developing country to reduce short-term complications is possible. However, since a small number of neonates were included in this study, further extensive studies involving large numbers of preterm neonates and multiple centers are needed to generalize the results to the study population.