665 - Role Of The SpO2/FiO2 Ratio As Very Early Indicator Of Success After 1st Surfactant Administration By LISA (1st LISA) In Preterm Infants In NCPAP For RDS

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 665
Publication Number: 665.442

Silvia Masseroni, University of Milan, Milano, Lombardia, Italy; Francesco Cavigioli, V.Buzzi Children’s Hospital, Milano, Lombardia, Italy; Sara Gatto, Children's Hospital “Vittore Buzzi”, Milan, Lombardia, Italy; Francesco Cerritelli, Foundation COME Collaboration, Pescara, Abruzzi, Italy; Marco Chiera, Foundation COME Collaboration, Lesmo (MB), Lombardia, Italy; Francesca Castoldi, NICU V.Buzzi Children Hospital, Milan, Lombardia, Italy; Alessandra Vittorini, Università degli studi di Napoli, Milano, Lombardia, Italy; Francesca Riccaboni, Università degli Studi di Milano, Milano, Lombardia, Italy; Gianluca Lista, NICU, V.Buzzi Children's Hospital, milan, Lombardia, Italy

Presenting Author(s)

Gianluca Lista (he/him/his)

Chief Neonatologist
NICU, V.Buzzi Children's Hospital
V.Buzzi Children's Hospital, ASST-FBF-Sacco
milan, Lombardia, Italy

Background:

The European RDS guidelines suggest surfactant administration if SpO2< 90% with FiO₂ >0.3. Less Invasive Surfactant Administration (LISA) is a largely used new technique to administer surfactant through a narrow catheter during non invasive ventilation (NIV) for RDS. Its safety, effectiveness and outcomes are still debated, especially in very premature newborns.

Objective:

To evaluate the effectiveness, tolerability and long term outcomes of the 1^st surfactant administration by LISA in terms of oxygenation and ventilation parameters in the first 24 hours and need for respiratory support and O₂ at 36 wks PMA. We also evaluated the role of SpO₂/FiO₂ ratio after LISA as a indicator of 1^st LISA success.

Design/Methods:

All inborn infants < 37 wks’ GA (March 2014- April 2022) managed from birth with NCPAP for RDS and treated with LISA were included and retrospectically reviewed. We identified two groups: 1^st LISA success group (GS no need of surfactant retreatment or intubation within 72 hrs after the 1^st LISA) and 1^st LISA failure group (GF need of surfactant retreatment or intubation within 72 hrs after the 1^st LISA). We compared oxygenation status (SpO₂, FiO₂, SpO₂/FiO₂), ventilation (level of CPAP) and respiratory outcomes (length of total respiratory support, NIV, MV and the need for CPAP and O₂ at 36 wks) in the two groups. We also studied a SpO₂/FiO₂ threshold of 310 as a post-manouver indicator of LISA success (corresponding to SpO₂ >= 90% and FiO₂ < 0.3).

Results:

112 infants (GA 30 wks (28-32), BW 1305g (984-1785) with mild to moderate RDS required LISA within a median of 5 (2-13) hrs of life. Median FiO₂ pre-LISA was 0,40 (0,35-0,45). 1st LISA GS and 1st LISA GF showed significant difference in BW, SpO₂/FiO₂ at 30’ after LISA, CPAP level at 24 hrs, length of any respiratory support and need for CPAP and O₂ at 36 wks (Fig 1-2). The multivariate regression showed: SpO₂/FiO₂ ratio≥ 310 at 30’ after LISA is a indicator of LISA success; the FiO2 level pre-LISA and time from birth-surfactant administration negatively correlate to the achievement of SpO₂/FiO₂ ratio >=310; a higher FiO₂ level pre-LISA and GA at birth< 28 wks correlate with LISA failure (Fig 3).

Conclusion(s):

The success of the 1^st LISA (no need of surfactant retreatment or MV within 72 hrs) is significantly associated with better respiratory short and long term outcomes. SpO₂/FiO₂ >310 at 30’ after LISA predicts success of the manouvre. Moreover, delay in surfactant administration or higher levels of pre-LISA FiO₂ negatively affected LISA success with high risk of adverse outcomes.