85 - A Survey of Surfactant Delivery Methods in Canada

Poster Number: 85
Publication Number: 85.438

Shaily Brahmbhatt, The University of Western Ontario - Schulich School of Medicine & Dentistry, London, ON, Canada; Brooke Read, London Health Sciences Centre, London, ON, Canada; Orlando P. DaSilva, The University of Western Ontario - Schulich School of Medicine & Dentistry, London, ON, Canada; Soume Bhattacharya, The University of Western Ontario - Schulich School of Medicine & Dentistry, London, ON, Canada

Background: Minimally Invasive Surfactant Therapy (MIST) can be used to treat neonatal respiratory distress syndrome in neonatal intensive care units (NICUs). Although MIST techniques have been found to minimize the risk for short and long-term complications in neonates, clinical and institutional variances in MIST utilization persist globally. Currently, little is known about institutional policies and clinician preferences in Canada.

Objective: The objective of this study was to survey the prevalence and implementation of MIST and explore clinician preferences for surfactant administration in tertiary care NICUs in Canada.

Design/Methods: An online survey was emailed to 33 tertiary-level participating centres of the Canadian Neonatal NetworkTM in April 2021. One response from each site was requested, completed by a physician, respiratory therapist, or registered nurse. The 33-item survey consisted of open and closed-ended questions, with a subset of questions for sites determined by their previous and current use of MIST. Site demographics and surfactant therapy procedural details were categorically collected using multiple-choice questions. Free text and multiple-choice questions were utilized to capture perceived barriers and individual preferences for MIST use. Quantitative analysis was captured using frequency and proportions.

Results: 28 of 33 participating members of the Canadian Neonatal Network™ and the EPIQ Lung Health Group completed the survey between April 2021 and October 2021 ( 85% ). 17/28 (61%) respondents reported ongoing MIST utilization at their center, with increasing utilization from 2018 onwards. Most centers that used MIST techniques administered Bovine Lipid Extract Surfactant (7/17, 68%), commonly administered using angiocatheters (8/17, 47%) and purpose-built catheters (41%). MIST was most used for patients at 26 to 33 weeks gestational age (15/17, 88%). Three of the nine centres that had never used MIST (9/28, 32%) indicated a plan to implement MIST within the next two years. Common barriers to MIST use included lack of consensus amongst clinicians (7/9, 78%), lack of training (5/9, 56%), and lack of experience with MIST techniques (5/9, 56%).Conclusion(s): Surfactant delivery using MIST is increasingly common in Canadian NICUs. Clinician experience and lack of consensus can contribute to the underutilization of MIST. National training workshops, data collection, and clinical guidelines should be established to minimize intuitional variances in MIST procedures.
Shaily Brahmbhatt, BSc MD-MPH(c) CVSBrahmbhatt_CV.pdf