The influence of the technique of surfactant administration (LISA vs INSURE) on the outcomes of respiratory distress syndrome treatment in preterm infants.

OBJECTIVE: Intratracheal administration of exogenous surfactant is a well-established therapy for respiratory distress syndrome in preterm infants. The two preferred methods for respiratory support in neonates that contribute to limiting the risk of lung damage associated with mechanical ventilation include nCPAP and non-invasive ventilation. The increasing popularity of surfactant administration techniques is due to the fact they reduce the time of mechanical ventilation until this medication is administered. In some cases a short period of mechanical ventilation follows (INSURE: INtubation-SURfactant-Extubation). There are also methods that make it possible to completely avoid intubation and help maintain spontaneous breathing during surfactant administration (LISA: Less Invasive Surfactant Administration, MIST: Minimal Invasive Surfactant Therapy). Aim: To analyze treatment outcomes in preterm infants who suffer from respiratory distress syndrome and require exogenous surfactant administration depending on the technique used: LISA vs INSURE.

PATIENTS AND METHODS: Material and methods: The present retrospective analysis included 129 infants born at a gestational age of between 24 and 33 weeks who were hospitalized in the Neonatology Department in the years 2014-2016, were administered surfactant and remained on non-invasive ventilation. All the subjects received only proractant alfa. Both study groups: LISA (n=83) and INSURE (n=46) were analyzed in terms of respiratory distress treatment outcomes and the presence of complications of prematurity.

RESULTS: Results: There were no significant differences in patient characteristics between the two study groups (LISA vs INSURE: mean birth body weight was 1210 g vs 1275 g, respectively; mean gestational age at birth was 30 weeks vs 29 6/7 weeks, respectively). The comparison of respiratory support method and FiO2 concentration within the first 72 hours after surfactant administration showed no significant differences between the groups. Similarly, respiratory outcomes did not significantly differ between the LISA and INSURE groups and were: the need for intubation ⎼ 42.2% vs 32.6%, p=0.201, duration of mechanical ventilation - median days 0 vs 0, p=0.377, duration of nCPAP - median days 5 vs 5, p=0.379, duration of oxygen supplementation - median days 1 vs 1, p=0.555, and the incidence of bronchopulmonary dysplasia - 28.9% vs 23.9%, p=0.506. Also, the incidence of complications was similar in both study groups.

CONCLUSION: Conclusions: Our retrospective analysis of preliminary outcomes of surfactant administration involving the use of the LISA technique showed no statistically significant differences as compared with the INSURE method. The randomized, prospective study that is currently being conducted at our Neonatology Department and includes biochemical markers of lung damage, will bring more objective data on the safety and effectiveness of both surfactant administration techniques (LISA vs INSURE).