654 - RDS-NExT Workshop: Consensus Statements for the Use of Surfactant in Preterm Neonates With RDS

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 654
Publication Number: 654.442

Vineet Bhandari, The Children's Regional Hospital at Cooper, Camden, NJ, United States; Rachel M. Black, AESARA Inc., Austin, TX, United States; Bheru B. Gandhi, Baylor College of Medicine, Sugar Land, TX, United States; Susan L. Hogue, AESARA, CHAPEL HILL, NC, United States; Venkatakrishna Kakkilaya, University of Texas Southwestern Medical School, Dallas, TX, United States; Michel Mikhael, CHILDREN'S HOSPITAL OF ORANGE COUNTY, ORANGE, CA, United States; Fernando R. Moya, University of North Carolina at Chapel Hill School of Medicine, Wilmington, NC, United States; Chad J. Pezzano, Albany Medical Center, Albany, NY, United States; Pamela M. Read, AESARA, Calgary, AB, Canada; Kari Roberts, Univ of MN, Mpls, MN, United States; Rita M. Ryan, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States; Richard H. Stanford, Aesara Inc, Chapel Hill, NC, United States; Clyde Wright, University of Colorado School of Medicine, Aurora, CO, United States

Presenting Author(s)

Vineet Bhandari, MD, DM (he/him/his)

Professor and Division Head
The Children's Regional Hospital at Cooper
Camden, New Jersey, United States

Background: There is a lack of consensus concerning surfactant use and administration in the neonatal setting and no US national guidelines. Variation exists at the institutional level in the management of neonates with respiratory distress syndrome (RDS), including neonates born at increasingly lower gestational ages, mode and timing of administration (as new, less-invasive, methods are being developed), and infant positioning during administration of surfactant. Gaps in evidence and shortcomings of existing randomized controlled trials (RCTs) further complicate bedside decision-making, leaving clinicians on their own to answer important questions about the patients they care for in the NICU.

Objective: To obtain consensus on aspects of best clinical practice for surfactant use in preterm neonates with RDS where critical gaps exist. The RDS-Neonatal Expert Taskforce (RDS-NExT) was convened to complement existing evidence and clinical guidelines, where evidence is lacking, with input from an expert panel with a US perspective.

Design/Methods: An expert panel of healthcare providers specializing in neonatal care in the US was convened and administered a survey questionnaire, followed by 3 moderated virtual workshops. A modified Delphi method was used to obtain consensus around key topics in surfactant use in neonatal RDS. Twenty-four statements were discussed and modified until panelists moved to vote, selecting their choice on a 5-point Likert scale (strongly disagree, disagree, neutral, agree, or strongly agree). Consensus was defined a priori as 80% of panelists selecting agree or strongly agree.

Results: Consensus was achieved on 20 statements (Table 1). Statements focused on establishing RDS diagnosis and indicators for surfactant administration, surfactant administration methods and techniques, and other considerations. Given the variability of neonates presenting with RDS, the panelists developed a surfactant indicator table incorporating multiple criteria for consideration when administering surfactant at various NICUs providing different levels of care in the US (Table 2).

Conclusion(s): These consensus statements provide practical guidance for surfactant administration in preterm neonates with RDS, contributing to improvement in the care of neonates and providing a stimulus for further investigation to bridge existing knowledge gaps.