438 - Comparison of Less Invasive Surfactant Administration using infant feeding tube with InSurE method in preterm infants between 26 and 34 weeks of gestation with RDS – A randomized control trial

Poster Number: 438
Publication Number: 438.227

Sushma Nangia, Lady Hardinge Medical College & Kalawati Saran Children's Hospital, New Delhi, Delhi, India; Rohit Anand, Others, New Delhi, Delhi, India

Background: There is growing evidence that less invasive surfactant administration (LISA) is a better alternative to the standard InSurE procedure in spontaneously breathing preterm infants with RDS. Issues related to LISA that still need to be resolved relate to the ideal type of catheter, the need for premedication or sedation, the most suited surfactant preparation, and the duration of surfactant administration. Special catheters used for surfactant administration in various studies are expensive and not easily available in resource constrained settings.

Objective: The present study was planned to compare the total duration of respiratory support in preterm infants with RDS undergoing LISA using an easily available and more cost-effective infant feeding tube with InSurE method.

Design/Methods: In this unblinded randomised controlled trial, 150 infants were allocated to LISA (n = 74) or InSurE group (n = 76). An 8F feeding tube was used for surfactant delivery in the LISA group. The primary outcome was the total duration of respiratory support and secondary outcomes included the proportion of babies with BPD, IVH, NEC, ROP, air leaks, CPAP failure and PDA requiring therapy. Additionally, need for invasive mechanical ventilation, need for repeat dose of surfactant therapy, time to regain birth weight, duration of hospitalization and death were also assessed.

Results: The baseline variables including birth weight and gestational age were similar in the two groups. Nearly 27% of the mothers did not receive any dose of antenatal steroids (ANS) while only around 37% of the mothers were completely covered with ANS with an overall high proportion of babies (59%) delivered by cesarean section. There was no statistically significant difference in the primary outcome of total duration of respiratory support in both groups with a median duration of 120 hours, 95%CI (69-235) and p-0.618. The need for invasive mechanical ventilation was significantly lower in LISA group (p-0.017) with RR (95%CI) 0.498(0.259 to 0.958). The CPAP failure was also significantly lower in the LISA group (p-0.005) with RR (95%CI) 0.55 (0.34 to 0.89). The total duration of hospital stay was reduced in the LISA group (19 days) compared to InSurE group (26 days) although the difference was not statistically significant. Other secondary outcomes assessed were not significantly different.Conclusion(s): LISA with an 8F feeding tube is a feasible and effective strategy for surfactant administration which resulted in a significant reduction in CPAP failure and duration of mechanical ventilatory support.
Table1. Baseline characteristics of neonates enrolled in study
Table 2: Outcome variables of two groups LISA and InSurE