Evaluation of a respiratory care protocol including less invasive surfactant administration in preterm infants

Background: Respiratory care protocol including less invasive śsurfactant administration (LISA) in ≤29 weeks’ gestational age (GA) infants introduced in October 2018. Methods: Retrospective study of infants admitted on continuous positive airway pressure (CPAP) October 2018 to December 2021. Maternal and neonatal variables were compared between infants managed on CPAP with and without LISA. Infants who received LISA and subsequently required mechanical ventilation (MV) within 72 h of life (HOL) [LISA failure (LF)] were compared with those who required no MV [LISA success (LS)]. Results: 249 infants were admitted on CPAP, 5 were intubated prior to LISA, 143 required LISA and 101 remained on CPAP without surfactant. Of those receiving LISA, 108 were LS and 35 were LF. Compared to LS, LF infants were of lower GA and birth weight, required higher fractional inspired oxygen (FiO₂), and CPAP level at birth, admission, one HOL, and an hour after LISA. Moreover, LF infants had higher mortality and morbidity. Together GA ≤ 25 weeks’ and FiO₂ ≥ 0.3 an hour after LISA best predicted LF. Conclusions: Over 80% of infants admitted on CPAP avoided MV within 72 HOL. Early predictors of LF provide targets for future interventions to decrease need for MV in preterm infants. Impact: Less invasive surfactant administration (LISA) decreases the need for mechanical ventilation (MV) and improves outcomes. However, some infants require MV within 72 h of life (HOL) despite LISA (LISA failure).Over 80% of ≤29 weeks’ gestational age (GA) infants can be successfully managed on CPAP with or without surfactant in the first 72 HOL.A combination of factors including ≤25 weeks’ GA and fraction of inspired oxygen ≥0.3 an hour after LISA predict LISA failure.Evaluation of a noninvasive respiratory support strategy including LISA provides targets for intervention to decrease need for MV in preterm infants.