741 - Implementation of Minimally Invasive Surfactant Therapy: Outcomes and Procedural Adverse Events

Premature infants are at risk for respiratory distress syndrome (RDS), and surfactant therapy is a common and evidence-based treatment. Surfactant is traditionally administered through an endotracheal tube (ETT). Minimally Invasive Surfactant Therapy (MIST) is an alternate technique to administer surfactant into the trachea using a thin catheter while the infant breathes on non-invasive support. Surfactant administration by MIST compared to an ETT has been associated with improved clinical outcomes. The use of this technique is growing, especially in the United States.

Objective:

To summarize the patient characteristics, procedural characteristics, and pertinent clinical outcomes including adverse events for MIST procedures performed at two hospitals: the Children’s Hospital of Philadelphia (CHOP) and the Hospital of the University of Pennsylvania (HUP).

Design/Methods:

We developed a protocol and introduced the MIST procedure for infants >28 weeks’ gestation and >750g with RDS at CHOP and HUP in January 2021. The protocol recommended the use of video laryngoscopy and premedication with atropine and fentanyl. This is a retrospective case series using manual chart reviews and prospectively collected procedural and outcome data for all MIST procedures from January 1, 2021 to November 30, 2022.

Results:

A total of 53 MIST procedures were performed on 51 infants during the study period (Table 1). MIST was performed twice on two infants. Nasal mask continuous positive airway pressure (CPAP) was the most common respiratory support before and during the procedure (Table 2). Surfactant was successfully administered in 50/53 (94%) of procedures; the catheter was successfully placed on the first attempt in 35/53 (66%) of procedures. The most common adverse event was positive pressure ventilation occurring in 9/53 (17%) of procedures. Severe oxygen desaturation (≥20% decline in SpO2) occurred in 31/48 (64%) of procedures, and bradycardia (heart rate < 100) occurred in 3/48 (6%) of procedures (Table 3). Within 48 hours after MIST, 35/51 (69%) of infants remained on non-invasive support.

Conclusion(s):

We implemented MIST at two hospitals with high procedural success and infrequent adverse events. Desaturation during the MIST procedure was common, but bradycardia was rare in the setting of standardized atropine premedication use.