Short-Term Outcome after Repeated Less Invasive Surfactant Administration: A Retrospective Cohort Study

Introduction: Less invasive surfactant administration (LISA) to preterm infants is associated with decreased risk for death or BPD. After LISA, a considerable proportion requires a second dose of surfactant because of ongoing respiratory distress syndrome, raising a clinical dilemma between intubati...

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Veröffentlicht in:Neonatology (Basel, Switzerland) Switzerland), 2022-12, Vol.119 (6), p.719-726
Hauptverfasser: Kleijkers, Lina M.P., Van Der Spil, Jooske, Janssen, Lobke C.E., Dieleman, Jeanne P., Andriessen, Peter, van Kaam, Anton H., Onland, Wes, Niemarkt, Hendrik J.
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container_issue 6
container_start_page 719
container_title Neonatology (Basel, Switzerland)
container_volume 119
creator Kleijkers, Lina M.P.
Van Der Spil, Jooske
Janssen, Lobke C.E.
Dieleman, Jeanne P.
Andriessen, Peter
van Kaam, Anton H.
Onland, Wes
Niemarkt, Hendrik J.
description Introduction: Less invasive surfactant administration (LISA) to preterm infants is associated with decreased risk for death or BPD. After LISA, a considerable proportion requires a second dose of surfactant because of ongoing respiratory distress syndrome, raising a clinical dilemma between intubation or performing a repeated LISA (re-LISA) procedure. We aim to assess efficacy of re-LISA in avoiding subsequent nasal continuous positive airway pressure failure (need for intubation in the first 72 h of life; CPAP-F), to identify factors associated with subsequent CPAP-F, and to compare short-term outcomes following re-LISA to surfactant retreatment by endotracheal intubation and mechanical ventilation. Methods: This was an observational retrospective study in two Dutch NICUs. Inclusion criterion was infants with gestational age 0.5 (OR 5.4, 95% CI: 2.0–14.7). Infants receiving re-LISA had a lower risk of death or BPD compared to infants intubated for the second surfactant dose (OR 0.4, 95% CI: 0.2–0.9). Infants with CPAP-F after re-LISA had similar outcomes compared to those intubated for second surfactant dose. Conclusion: Re-LISA is effective in reducing CPAP-F and is associated with lower risk of death or BPD compared to retreatment via an endotracheal tube. Infants failing CPAP after re-LISA have similar outcomes compared to intubated infants. These findings support the use of re-LISA in preterm infants with ongoing RDS.
doi_str_mv 10.1159/000526493
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After LISA, a considerable proportion requires a second dose of surfactant because of ongoing respiratory distress syndrome, raising a clinical dilemma between intubation or performing a repeated LISA (re-LISA) procedure. We aim to assess efficacy of re-LISA in avoiding subsequent nasal continuous positive airway pressure failure (need for intubation in the first 72 h of life; CPAP-F), to identify factors associated with subsequent CPAP-F, and to compare short-term outcomes following re-LISA to surfactant retreatment by endotracheal intubation and mechanical ventilation. Methods: This was an observational retrospective study in two Dutch NICUs. Inclusion criterion was infants with gestational age &lt;32 0/7 weeks requiring a second surfactant dose. Multivariate logistic regression analysis was performed. Results: Of 209 infants requiring second surfactant dose, 132 received re-LISA. Subsequent CPAP-F was observed in 56 (42%) infants and was associated with extreme prematurity (OR 2.6, 95% CI: 1.2–5.8) and FiO 2 &gt;0.5 (OR 5.4, 95% CI: 2.0–14.7). Infants receiving re-LISA had a lower risk of death or BPD compared to infants intubated for the second surfactant dose (OR 0.4, 95% CI: 0.2–0.9). Infants with CPAP-F after re-LISA had similar outcomes compared to those intubated for second surfactant dose. Conclusion: Re-LISA is effective in reducing CPAP-F and is associated with lower risk of death or BPD compared to retreatment via an endotracheal tube. Infants failing CPAP after re-LISA have similar outcomes compared to intubated infants. These findings support the use of re-LISA in preterm infants with ongoing RDS.</description><identifier>ISSN: 1661-7800</identifier><identifier>EISSN: 1661-7819</identifier><identifier>DOI: 10.1159/000526493</identifier><identifier>PMID: 36126636</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject>Analysis ; Continuous positive airway pressure ; Humans ; Infant, Newborn ; Infant, Premature ; Infants (Premature) ; Original Paper ; Retrospective Studies ; Surface active agents</subject><ispartof>Neonatology (Basel, Switzerland), 2022-12, Vol.119 (6), p.719-726</ispartof><rights>2022 S. Karger AG, Basel</rights><rights>2022 S. Karger AG, Basel.</rights><rights>COPYRIGHT 2022 S. Karger AG</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c432t-a44f80eb15be4018329aa33da51f1206261af150d82fabcdab0338e0ae4b7f6d3</citedby><cites>FETCH-LOGICAL-c432t-a44f80eb15be4018329aa33da51f1206261af150d82fabcdab0338e0ae4b7f6d3</cites><orcidid>0000-0002-5159-6874 ; 0000-0002-0844-7208 ; 0000-0002-9623-0606 ; 0000-0003-4030-7085</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,2423,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36126636$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kleijkers, Lina M.P.</creatorcontrib><creatorcontrib>Van Der Spil, Jooske</creatorcontrib><creatorcontrib>Janssen, Lobke C.E.</creatorcontrib><creatorcontrib>Dieleman, Jeanne P.</creatorcontrib><creatorcontrib>Andriessen, Peter</creatorcontrib><creatorcontrib>van Kaam, Anton H.</creatorcontrib><creatorcontrib>Onland, Wes</creatorcontrib><creatorcontrib>Niemarkt, Hendrik J.</creatorcontrib><title>Short-Term Outcome after Repeated Less Invasive Surfactant Administration: A Retrospective Cohort Study</title><title>Neonatology (Basel, Switzerland)</title><addtitle>Neonatology</addtitle><description>Introduction: Less invasive surfactant administration (LISA) to preterm infants is associated with decreased risk for death or BPD. After LISA, a considerable proportion requires a second dose of surfactant because of ongoing respiratory distress syndrome, raising a clinical dilemma between intubation or performing a repeated LISA (re-LISA) procedure. We aim to assess efficacy of re-LISA in avoiding subsequent nasal continuous positive airway pressure failure (need for intubation in the first 72 h of life; CPAP-F), to identify factors associated with subsequent CPAP-F, and to compare short-term outcomes following re-LISA to surfactant retreatment by endotracheal intubation and mechanical ventilation. Methods: This was an observational retrospective study in two Dutch NICUs. Inclusion criterion was infants with gestational age &lt;32 0/7 weeks requiring a second surfactant dose. Multivariate logistic regression analysis was performed. Results: Of 209 infants requiring second surfactant dose, 132 received re-LISA. Subsequent CPAP-F was observed in 56 (42%) infants and was associated with extreme prematurity (OR 2.6, 95% CI: 1.2–5.8) and FiO 2 &gt;0.5 (OR 5.4, 95% CI: 2.0–14.7). Infants receiving re-LISA had a lower risk of death or BPD compared to infants intubated for the second surfactant dose (OR 0.4, 95% CI: 0.2–0.9). Infants with CPAP-F after re-LISA had similar outcomes compared to those intubated for second surfactant dose. Conclusion: Re-LISA is effective in reducing CPAP-F and is associated with lower risk of death or BPD compared to retreatment via an endotracheal tube. Infants failing CPAP after re-LISA have similar outcomes compared to intubated infants. These findings support the use of re-LISA in preterm infants with ongoing RDS.</description><subject>Analysis</subject><subject>Continuous positive airway pressure</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Infant, Premature</subject><subject>Infants (Premature)</subject><subject>Original Paper</subject><subject>Retrospective Studies</subject><subject>Surface active agents</subject><issn>1661-7800</issn><issn>1661-7819</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpt0U1r3DAQBmBTWpo06aH3UgyBkh6c6sOS7d6WJUkDSxey6dmMrdGuW9tyJDmQf18ZpyaBoIOE9LwDo4miT5RcUCqK74QQwWRa8DfRMZWSJllOi7fLmZCj6INzf4ISQrL30RGXlEnJ5XG03x2M9ckd2i7ejr42HcagPdr4FgcEjyreoHPxTf8ArnnAeDdaDbWH3scr1TV947wF35j-R7wKGW-NG7D2E12bqXa886N6PI3eaWgdfnzaT6LfV5d365_JZnt9s15tkjrlzCeQpjonWFFRYUpozlkBwLkCQTVlRDJJQVNBVM40VLWCinCeIwFMq0xLxU-i87nuYM39iM6XXeNqbFvo0YyuZBmVggmaiUDPZrqHFsum1yZ0Uk-8XGWsYDkVvAjq4hUVlsKuqU2Pugn3LwJfnwUOCK0_ONOO0x-5l_DbDOvwZ86iLgfbdGAfS0rKaa7lMtdgvzy1NVYdqkX-H2QAn2fwF-we7QKW_Nmrz78ut7MoB6X5P-yRsH8</recordid><startdate>20221201</startdate><enddate>20221201</enddate><creator>Kleijkers, Lina M.P.</creator><creator>Van Der Spil, Jooske</creator><creator>Janssen, Lobke C.E.</creator><creator>Dieleman, Jeanne P.</creator><creator>Andriessen, Peter</creator><creator>van Kaam, Anton H.</creator><creator>Onland, Wes</creator><creator>Niemarkt, Hendrik J.</creator><general>S. 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After LISA, a considerable proportion requires a second dose of surfactant because of ongoing respiratory distress syndrome, raising a clinical dilemma between intubation or performing a repeated LISA (re-LISA) procedure. We aim to assess efficacy of re-LISA in avoiding subsequent nasal continuous positive airway pressure failure (need for intubation in the first 72 h of life; CPAP-F), to identify factors associated with subsequent CPAP-F, and to compare short-term outcomes following re-LISA to surfactant retreatment by endotracheal intubation and mechanical ventilation. Methods: This was an observational retrospective study in two Dutch NICUs. Inclusion criterion was infants with gestational age &lt;32 0/7 weeks requiring a second surfactant dose. Multivariate logistic regression analysis was performed. Results: Of 209 infants requiring second surfactant dose, 132 received re-LISA. Subsequent CPAP-F was observed in 56 (42%) infants and was associated with extreme prematurity (OR 2.6, 95% CI: 1.2–5.8) and FiO 2 &gt;0.5 (OR 5.4, 95% CI: 2.0–14.7). Infants receiving re-LISA had a lower risk of death or BPD compared to infants intubated for the second surfactant dose (OR 0.4, 95% CI: 0.2–0.9). Infants with CPAP-F after re-LISA had similar outcomes compared to those intubated for second surfactant dose. Conclusion: Re-LISA is effective in reducing CPAP-F and is associated with lower risk of death or BPD compared to retreatment via an endotracheal tube. Infants failing CPAP after re-LISA have similar outcomes compared to intubated infants. These findings support the use of re-LISA in preterm infants with ongoing RDS.</abstract><cop>Basel, Switzerland</cop><pub>S. 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source Karger Journals; MEDLINE; Alma/SFX Local Collection
subjects Analysis
Continuous positive airway pressure
Humans
Infant, Newborn
Infant, Premature
Infants (Premature)
Original Paper
Retrospective Studies
Surface active agents
title Short-Term Outcome after Repeated Less Invasive Surfactant Administration: A Retrospective Cohort Study
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