661 - Predictors and Outcomes of Less Invasive Surfactant Administration Failure in ≤29 week gestational age infants

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 661
Publication Number: 661.442

Swathi Ariyapadi, University of Texas Southwestern Medical School, Euless, TX, United States; Melody Chiu, University of Texas Southwestern Medical School, Dallas, TX, United States; Lebanon David, University of Texas Southwestern Medical Center, Dallas, TX, United States; Christina Chan, University of Texas Southwestern Medical School, Dallas, TX, United States; Kathryn G. Mazioniene, University of Texas Southwestern Medical School, Willow Park, TX, United States; Patti J. Burchfield, University of Texas Southwestern Medical School, Dallas, TX, United States; Larry S. Brown, Parkland Health, Dallas, TX, United States; Vishal Kapadia, University of Texas Southwestern Medical School, Dalls, TX, United States; Venkatakrishna Kakkilaya, University of Texas Southwestern Medical School, Dallas, TX, United States

Presenting Author(s)

Swathi Ariyapadi, MD, MPH (she/her/hers)

Pediatric Resident
University of Texas Southwestern Medical School
Euless, Texas, United States

Background: Less Invasive Surfactant Administration (LISA) using thin catheter decrease the need for mechanical ventilation (MV) and improve outcomes. Starting October 2018, we implemented OPTISURF bundle consisting of stepwise escalation of CPAP from 5 to 7 cm H₂O and administration of LISA guided by fractional inspired oxygen (FiO₂) ≥0.3. Compared to historical cohort, our center reported decreased need for MV within 72 hours of life (45% vs 11%) and pneumothorax after implementing the bundle in infants ≤ 29 week gestational age (GA).

Objective: To identify risk factors for the need for MV within 7 days of life after LISA in ≤29 week GA infants.

Design/Methods: This is a single center retrospective study of infants 22-29 week GA admitted on CPAP to neonatal intensive care unit (NICU) and requiring LISA between October 2018 and December 2021. We compared maternal and neonatal variables between the group of infants maintained on CPAP without MV during the first 7 days of life [LISA success group (LSG)] and the group of infants who required MV during the same period [LISA failure group (LFG)].

Results: Of the 250 infants admitted on CPAP, 143 infants (56%) received LISA (Figure 1). Among the 143 infants receiving LISA, 105 infants belonged to LSG and 38 (26%) infants to LFG. Compared to LSG, infants in the LFG were of lower median GA (p< 0.01), birth weight (p< 0.01), median Apgar scores at both 1 and 5 minutes of life (p< 0.05), and higher incidence of hypothermia (< 36*C) within first four hours of life (p< 0.01). Similarly, infants in the LFG required higher median FiO₂ and CPAP at birth (p< 0.01), at admission (p< 0.01), first two hours of life (Table 1) and at 4 hours after LISA (p< 0.01) (Table 2). Infants in the LFG had higher incidence of pneumothorax (p=0.03), pulmonary hemorrhage (p< 0.01), severe intraventricular hemorrhage (p< 0.01), severe retinopathy of prematurity (p< 0.01) and mortality (p < 0.01) (Table 2). Forward step logistic regression showed that GA ≤26 week GA and FiO₂≥0.3 at 4 hours of life are the best predictors of LISA failure (area under the curve 0.80)

Conclusion(s): Infants failing CPAP after LISA are at increased risk for worse short-term outcomes. LISA failure can be predicted by combination of ≤26 week GA and FiO₂ ≥0.3 at 4 hours after LISA. This information can help design further prospective studies to decrease LISA failure and improve outcomes.