435 - Effectiveness of CPAP Optimization and Less Invasive Surfactant Administration (LISA) Strategy in 35-38 Weeks GA Infants

Poster Number: 435
Publication Number: 435.430

Etze Chotzoglou, University of Texas Southwestern Medical School, Dallas, TX, United States; Heather Weydig, University of Texas Southwestern Medical School, Dallas, TX, United States; Vishal Kapadia, University of Texas Southwestern Medical School, Dallas, TX, United States; Larry S. Brown, Parkland Health & Hospital System, Dallas, TX, United States; Patti J. Burchfield, University of Texas Southwestern Medical School, Dallas, TX, United States; Venkat Kakkilaya, UT Southwestern Medical Center, Plano, TX, United States

Background: Although traditionally surfactant was administered via an endotracheal tube (ETT), less invasive surfactant administration (LISA) using a thin catheter has shown to decrease the mechanical ventilation (MV) need and improve outcomes in preterm infants. The benefits of LISA on late preterm infants are not well established. Starting October 2018, our center implemented the ‘OPTISURF’ bundle consisting of optimization of continuous positive airway pressure (CPAP) and LISA guided by fractional inspired oxygen (FIO2)≥0.3. We reported a decrease in the CPAP failure and pneumothorax in preterm infants < 30 week gestational age (GA) after implementation of the OPTISURF bundle compared to historical controls.

Objective: 1) Determine whether management of the late preterm and early term infants changed after the OPTISURF was implemented in the neonatal intensive care unit. 2) Identify the effects of OPTISURF (OSC) in 35-38 weeks GA infants on MV need within 72 hours of life (HOL).

Design/Methods: Infants with 35-38 weeks GA, born between January 2016 and July 2021, and required at least two days of CPAP or MV for respiratory distress were included. Infants born between January 2016 and September 2018 were included in Pre-OSC and those born between October 2018 and July 2021 were included in the Post-OSC cohort. Demographics, respiratory severity score (RSS) on admission, at two and four HOL, mortality, length of hospitalization (adjusted for GA), and MV were compared between cohorts.

Results: Our study included 225 late preterm and term infants. There were 113 babies in the Pre- and 112 in the Post-OSC cohort. There was no difference in maternal and infant characteristics, RSS on admission, at 2 and 4 HOL between two cohorts. Overall, 13 (12%) infants in Pre-OSC and 29 (26%) in the Post-OSC cohort received surfactant (p < .01). Of the 29 infants that received surfactant in the Post-OSC, 86% received LISA, and the rest via ETT. Among 25 infants who received LISA, only one infant required MV during the hospital stay. There was no difference in the need for MV, pneumothorax, or duration of MV between the two cohorts. Compared to Pre-OSC, infants in the Post-OSC required a longer duration of supplemental oxygen and longer hospital stay. Conclusion(s): After implementation of OPTISURF bundle in preterm infants < 30 weeks GA, the use of surfactant increased even in the 35-38 weeks GA infants. There was no difference in any respiratory outcomes despite the higher use of surfactant in this group of infants. Further studies are necessary to evaluate the benefits of the OPTISURF bundle in later preterm and term infants.
CVetze_chotzoglou_cv_1.4.21.pdf
Table 1.Maternal characteristics of the infants included in our study. Categorical variables were presented as percentages. Continuous variables were presented as median (25th- 75th percentile).