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Letter
UK survey of less invasive surfactant administration
  1. Eleanor Jeffreys1,2,
  2. Katie Hunt1,2,
  3. Theodore Dassios2,3,
  4. Anne Greenough1,2
  1. 1 Department of Women and Children’s Health, School of Life Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
  2. 2 MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, London, UK
  3. 3 Neonatal Intensive Care Unit, King’s College Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Professor Anne Greenough, Department of Women and Children’s Health, School of Life Sciences, Faculty of Life Science and Medicine, King’s College London, London SE5 9RS; anne.greenough{at}kcl.ac.uk

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Increasing use of non-invasive ventilation has led to the development of techniques which deliver surfactant without resort to intubation. These are called less invasive surfactant administration (LISA) or minimally invasive surfactant therapy (MIST). A systematic review of six randomised controlled trials demonstrated LISA use in infants with respiratory distress syndrome was associated with a reduced incidence of bronchopulmonary dysplasia and death at 36 weeks and need for mechanical ventilation1; the latter was also reported in a further systematic review.2 A survey of LISA use across Europe demonstrated variation in practice.3 Only 12 UK units, however, were included hence we determined current practice regarding LISA in all levels of UK neonatal units. An online questionnaire was sent to all 196 neonatal units between May and July in 2018. The clinicians were asked about use of LISA in the labour suite and the neonatal unit, technique and equipment used, if premedication was given and if side effects had been experienced.

There was a 95% response rate. Fifty-eight responders were neonatal intensive care units (NICU n=62), 84 local neonatal units (LNU n=88) and 45 special care baby units (SCBU n=46). LISA was used regularly in 35 (18.7%) units; 20 (34.5%) NICUs, 9 (10.7%) LNUs and 6 (13.3%) SCBUs. Only four performed LISA in the delivery room. LISA was performed by consultants in 91.7% of units, registrars or equivalent in 69.4% and Senior House Officer or equivalent in 25%. Criteria for using LISA varied; 62.5% used LISA if the fraction of inspired oxygen concentration (FiO2) was >0.3, 46.9% an FiO2 >0.4% and 9.4% an FiO2 >0.5; 25% gave LISA in infants <24 weeks of gestation, 34.4% between 24 and 25 weeks, 59.4% in between 26 and 28 weeks, 71.9% between 28 and 30 weeks, 75% between 30 and 32 weeks and 62.5% >32 weeks of gestational age.

Forty-nine per cent did not use sedation/premedication with LISA; others used a variety of ‘medications’ (table 1). The majority 28 (80%) used the LISAcath, six (17.1%) a feeding catheter, four (11.4%) a vascular catheter and three (8.6%) a surfactant giving set; 97% of clinicians inserted the catheter orally and 22% used Magill forceps. Ninety-seven per cent of respondents gave 200 mg/kg of surfactant and the majority (61.8%) gave it over 1–3 min, 17.6% in <1 min and 20.6% in >3 min; 68% gave the surfactant as one bolus and 32.4% in two to four small boluses. No adverse effects were reported by 19 (54.3%) respondents. The most common side effects were bradycardia (18.8%), hypoxia (15.6%) and surfactant reflux into the oropharynx (15.6%): only one reported intubation had been required following LISA.

Table 1

Use of ‘medication’ with less invasive surfactant administration data is presented as number of respondents (%)

We have demonstrated that LISA was uncommon in the UK. Despite being more commonly used in Europe, as in the UK, criteria for use and policies concerning premedications, devices and technique of LISA/MIST varied.3 In conclusion, our results and those from the literature emphasise more research is needed to identify the best practice regarding LISA.

References

Footnotes

  • Contributors AG, EJ and KH designed the study. EJ and KH undertook the survey, EJ and KH undertook the analysis. EJ wrote the first draft and all authors produced the final manuscript.

  • Funding This research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St Thomas' NHS Foundation Trust and King’s College London.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement We are happy to share data on request.

  • Patient consent for publication Not required.

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