Effectiveness of A Respiratory Care Protocol Including Less Invasive Surfactant Administration in ≥ 35 Weeks Gestational Age Infants

Background: In October 2018, a respiratory care protocol (RCP) including less invasive surfactant administration (LISA), was introduced for preterm infants admitted on continuous positive airway pressure (CPAP). Study Design: We compared respiratory care practices and outcomes of ≥ 35-week gestational age (GA) infants between a pre-RCP (Jan 2016 to September 2018) and a post-RCP cohort (Oct 2018 to Dec 2021). Infants requiring < 24 h of CPAP and diagnosed with meconium aspiration syndrome were excluded. Results: Of the 260 infants meeting inclusion criteria, 126 belonged to the pre-RCP and 134 to post-RCP cohort. Compared to pre-RCP, a lower proportion of infants in the post-RCP received CPAP on admission but a higher proportion received surfactant therapy (8% vs 22%, p < 0.001). Notably, surfactant therapy was associated with lower FiO₂ requirement for 24 h and respiratory severity score for 48 h in the post-RCP cohort. However, there was no difference in any of the outcomes such as the need for mechanical ventilation, incidence of pneumothorax and length of hospital stay between two cohorts. Conclusions: Implementing an RCP increased surfactant use with associated improvement in oxygenation but did not improve outcomes. Further studies are necessary to evaluate the role of LISA in ≥ 35-week GA infants.